{"id":1958,"date":"2020-04-04T20:10:56","date_gmt":"2020-04-04T18:10:56","guid":{"rendered":"https:\/\/rrygm.beeweb-green.io\/?page_id=1958"},"modified":"2024-03-27T20:50:44","modified_gmt":"2024-03-27T19:50:44","slug":"prijimaci-formular","status":"publish","type":"page","link":"https:\/\/tre-online.com\/cs\/tre-online-learn-how-to\/intake-form\/","title":{"rendered":"U\u010den\u00ed TRE\u00ae: Formul\u00e1\u0159 pro p\u0159ijet\u00ed\/odhalen\u00ed"},"content":{"rendered":"<div class=\"wp-block-media-text alignwide is-stacked-on-mobile\" style=\"grid-template-columns:45% auto\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"https:\/\/tre-online.com\/wp-content\/uploads\/2020\/04\/LogoStress_noExerc3.jpg\" alt=\"\" class=\"wp-image-1971 size-full\"\/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>INDEMNITY<\/strong><br>TRE\u00ae nen\u00ed ur\u010den k diagnostice, l\u00e9\u010db\u011b, vyl\u00e9\u010den\u00ed nebo prevenci jak\u00e9hokoli onemocn\u011bn\u00ed. TRE\u00ae je bezpe\u010dn\u00e1 a \u00fa\u010dinn\u00e1 technika uvol\u0148ov\u00e1n\u00ed stresu pro v\u011bt\u0161inu lid\u00ed.<\/p>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Proces TRE\u00ae by nem\u011bl b\u00fdt pou\u017e\u00edv\u00e1n jako n\u00e1hrada za postupy zotaven\u00ed po traumatu l\u00e9ka\u0159sk\u00e9 nebo psychiatrick\u00e9\/psychologick\u00e9 povahy. Osoby, kter\u00e9 maj\u00ed fyzick\u00e9 nebo psychick\u00e9 pot\u00ed\u017ee vy\u017eaduj\u00edc\u00ed p\u0159\u00edsnou regulaci, osoby s k\u0159ehkou psychickou obranyschopnost\u00ed, slo\u017eitou anamn\u00e9zou traumatu nebo omezuj\u00edc\u00edmi fyzick\u00fdmi \u010di zdravotn\u00edmi omezen\u00edmi by se m\u011bly p\u0159ed prov\u00e1d\u011bn\u00edm t\u011bchto cvi\u010den\u00ed poradit se sv\u00fdm l\u00e9ka\u0159em. V\u00fdsledky se mohou u jednotliv\u00fdch osob li\u0161it. Neexistuj\u00ed \u017e\u00e1dn\u00e9 z\u00e1ruky, a\u0165 u\u017e vyj\u00e1d\u0159en\u00e9, nebo p\u0159edpokl\u00e1dan\u00e9.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D\u016eV\u011aRNOST<\/strong><br>V\u0161e, o \u010dem se v r\u00e1mci na\u0161\u00ed spole\u010dn\u00e9 pr\u00e1ce hovo\u0159\u00ed, z\u016fst\u00e1v\u00e1 d\u016fv\u011brn\u00e9 a nesm\u00ed b\u00fdt sd\u011bleno \u017e\u00e1dn\u00e9 t\u0159et\u00ed stran\u011b s v\u00fdjimkou doporu\u010duj\u00edc\u00edho l\u00e9ka\u0159e. Pokud se \u00fa\u010dastn\u00edte skupinov\u00e9 pr\u00e1ce, nesm\u00ed b\u00fdt mimo skupinu prozrazeny \u017e\u00e1dn\u00e9 identifika\u010dn\u00ed materi\u00e1ly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>UVOLN\u011aN\u00cd<\/strong><br>Beru na v\u011bdom\u00ed, \u017ee se dobrovoln\u011b \u00fa\u010dastn\u00edm soukrom\u00e9ho nebo skupinov\u00e9ho sezen\u00ed v TRE.<strong>\u00ae<\/strong> z vlastn\u00ed v\u016fle. Jsem si v\u011bdom toho, \u017ee praktikov\u00e1n\u00edm TRE<strong>\u00ae<\/strong>, p\u0159eb\u00edr\u00e1m a p\u0159ij\u00edm\u00e1m riziko jak\u00e9hokoli nep\u0159\u00edzniv\u00e9ho v\u00fdsledku, kter\u00fd by mohl nastat. Beru na v\u011bdom\u00ed, \u017ee svou \u00fa\u010dast mohu kdykoli p\u0159eru\u0161it a \u017ee m\u00e1m kontrolu nad intenzitou, s jakou budu prov\u00e1d\u011bt TRE<strong>\u00ae<\/strong>. P\u0159ij\u00edm\u00e1m plnou odpov\u011bdnost za p\u0159\u00edpadn\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky nebo zm\u011bny v m\u00e9m \u017eivot\u011b, kter\u00e9 prov\u00e1d\u011bj\u00ed TRE<strong>\u00ae<\/strong> m\u016f\u017ee zp\u016fsobit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jsem si v\u011bdom toho, \u017ee a\u010dkoli je Deva Laya Guleng certifikovan\u00fdm TRE.<strong>\u00ae<\/strong> Poskytovatel\/\u0161kolitel, nen\u00ed licencovan\u00fdm l\u00e9ka\u0159em, a proto neposkytuje l\u00e9ka\u0159sk\u00e9 rady. Beru na v\u011bdom\u00ed, \u017ee mi nedoporu\u010duje p\u0159estat u\u017e\u00edvat p\u0159edepsan\u00e9 l\u00e9ky, l\u00e9\u010dbu nebo poradenstv\u00ed v oblasti du\u0161evn\u00edho zdrav\u00ed bez konzultace s l\u00e9ka\u0159em nebo poradcem.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Souhlas\u00edm s t\u00edm, \u017ee p\u0159eb\u00edr\u00e1m plnou odpov\u011bdnost za sv\u00e9 fyzick\u00e9 a emocion\u00e1ln\u00ed zdrav\u00ed a zbavuji spole\u010dnost Deva Laya Guleng a OmniBalance jak\u00e9koli pr\u00e1vn\u00ed, finan\u010dn\u00ed a zdravotn\u00ed odpov\u011bdnosti vypl\u00fdvaj\u00edc\u00ed z m\u00e9ho vzd\u011bl\u00e1vac\u00edho procesu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>V\u00ddUKA TRE\u00ae PRO OSTATN\u00cd<\/strong><br>Beru na v\u011bdom\u00ed, \u017ee nejsem certifikovan\u00fdm poskytovatelem TRE.<strong>\u00ae<\/strong> po absolvov\u00e1n\u00ed individu\u00e1ln\u00edch nebo skupinov\u00fdch sezen\u00ed, a proto nejsem vy\u0161kolen k tomu, abych po absolvov\u00e1n\u00ed sezen\u00ed (soukrom\u00e9ho\/skupinov\u00e9ho) u\u010dil ostatn\u00ed, jak to d\u011blat. Pokud u\u010d\u00edm TRE<strong>\u00ae<\/strong>, p\u0159ij\u00edm\u00e1m plnou odpov\u011bdnost za jak\u00e9koli n\u00e1roky, \u017ealoby nebo \u0159\u00edzen\u00ed, kter\u00e9 proti mn\u011b vznese kdokoli, koho u\u010d\u00edm, \u010d\u00edm\u017e osvobozuji spole\u010dnosti Deva Laya Guleng, OmniBalance, TRE.<strong>\u00ae<\/strong> LLC a Dr. Davida Berceliho z jak\u00e9koli pr\u00e1vn\u00ed, finan\u010dn\u00ed a l\u00e9ka\u0159sk\u00e9 odpov\u011bdnosti, kter\u00e1 by mohla vzniknout.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>KONTRAINDIKACE<\/strong><br>Pou\u017eit\u00ed p\u0159\u00edpravku TRE\u00ae je kontraindikov\u00e1no, pokud trp\u00edte epilepsi\u00ed, m\u00e1te z\u00e1chvaty, jste v sou\u010dasn\u00e9 dob\u011b t\u011bhotn\u00e1, b\u011bhem posledn\u00edch 3 m\u011bs\u00edc\u016f jste prod\u011blala operaci otev\u0159en\u00e9 r\u00e1ny nebo jste porodila. <br><br><strong>NEMOCNICE<\/strong><br>M\u011bjte na pam\u011bti, \u017ee pokud se v den sezen\u00ed s poskytovatelem TRE\u00ae vyskytne v t\u011ble infekce, m\u011bli byste o tom co nejd\u0159\u00edve informovat poskytovatele TRE\u00ae (nejl\u00e9pe den(y) p\u0159edem, pokud je to mo\u017en\u00e9), abyste si mohli sezen\u00ed p\u0159eobjednat na jin\u00fd den. <\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1990-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1990\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/cs\/wp-json\/wp\/v2\/pages\/1958#wpcf7-f1990-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/cs\/wp-json\/wp\/v2\/pages\/1958#wpcf7-f1990-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1990\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1990-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li class=\"active\">\n\t\t\t<p>Osobn\u00ed \u00fadaje (1\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Zdravotn\u00ed stavy\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Dal\u0161\u00ed\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Podpis\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td width=\"50%\">\n\t\t\t<p><label>Jm\u00e9no <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"50%\" colspan=\"2\">\n\t\t\t<p><label>P\u0159\u00edjmen\u00ed <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"surname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"surname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td  width=\"50%\">\n\t\t\t<p><label>Datum narozen\u00ed <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date-of-birth\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>V\u011bk <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"age\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td  width=\"25%\">\n\t\t\t<p><label>Pohlav\u00ed <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Male\">Mu\u017ei<\/option><option value=\"Female\">\u017deny<\/option><option value=\"Other\">Dal\u0161\u00ed<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Mobiln\u00ed <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cellphone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cellphone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Povol\u00e1n\u00ed <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>M\u011bsto <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Zem\u011b <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>E-mail <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Dal\u0161\u00ed p\u0159\u00edbuzn\u00ed \/ kontakt v p\u0159\u00edpad\u011b nouze - jm\u00e9no <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Dal\u0161\u00ed p\u0159\u00edbuzn\u00ed \/ kontakt pro p\u0159\u00edpad nouze - telefonn\u00ed \u010d\u00edslo <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Nejbli\u017e\u0161\u00ed p\u0159\u00edbuzn\u00ed \/ kontakt pro p\u0159\u00edpad nouze <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n\n<!-- page 2 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Osobn\u00ed \u00fadaje\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Ot\u00e1zky (2\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Zdravotn\u00ed stavy\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Dal\u0161\u00ed\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Podpis\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>U\u017e jste n\u011bkdy d\u011blali TRE\u00ae? <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Pokud ano, popi\u0161te pros\u00edm sv\u00e9 zku\u0161enosti s TRE\u00ae - jak dlouho cvi\u010d\u00edte, kde a kdy jste se to nau\u010dili, jak \u010dasto se t\u0159esete a jak\u00e9 v\u00fdznamn\u00e9 zm\u011bny nastaly. <\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"done-tre-before\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"done-tre-before\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>V co douf\u00e1te, \u017ee se d\u00edky TRE\u00ae zm\u011bn\u00ed?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tre-expectations\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"tre-expectations\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>M\u00e1te v sou\u010dasn\u00e9 dob\u011b n\u011bjak\u00e9 zdravotn\u00ed pot\u00ed\u017ee? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medical-issues\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"medical-issues\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ano<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"medical-issues\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Ne<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Uve\u010fte podrobnosti o p\u0159\u00edpadn\u00fdch srde\u010dn\u00edch pot\u00ed\u017e\u00edch, nepravideln\u00e9m krevn\u00edm tlaku, epilepsii, cukrovce nebo trval\u00e9 chronick\u00e9 bolesti. <\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"medical-issues-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"medical-issues-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>M\u00e1te n\u011bjak\u00e9 smyslov\u00e9 posti\u017een\u00ed (nap\u0159\u00edklad ztr\u00e1tu zraku nebo sluchu nebo probl\u00e9my s rovnov\u00e1hou)? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sensory-impariment\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"sensory-impariment\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ano<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"sensory-impariment\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Ne<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Pokud ano, vysv\u011btlete pros\u00edm, jak\u00e9 smyslov\u00e9 posti\u017een\u00ed m\u00e1te:<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sensory-impariment-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"sensory-impariment-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Dost\u00e1v\u00e1te (nebo jste dost\u00e1vali) v sou\u010dasn\u00e9 dob\u011b n\u011bjakou psychiatrickou p\u00e9\u010di, terapii nebo poradenstv\u00ed v oblasti \u00fazkosti, deprese nebo jin\u00fdch psychick\u00fdch probl\u00e9m\u016f? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"psychiatric-care\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"psychiatric-care\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ano<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"psychiatric-care\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Ne<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Uve\u010fte pros\u00edm podrobnosti o jak\u00e9koli l\u00e9\u010db\u011b, kterou jste podstoupili b\u011bhem posledn\u00edch 12 m\u011bs\u00edc\u016f.<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychiatric-care-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"psychiatric-care-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Jak\u00e9 l\u00e9ky (na p\u0159edpis nebo voln\u011b prodejn\u00e9), vitam\u00edny, dopl\u0148ky stravy nebo p\u0159\u00edrodn\u00ed prost\u0159edky pravideln\u011b u\u017e\u00edv\u00e1te?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"vitamins-supplements-medications\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"vitamins-supplements-medications\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Za\u017eil\/a jste v posledn\u00edch 24 m\u011bs\u00edc\u00edch n\u011bjak\u00e9 trauma? <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Pokud ano, vysv\u011btlete to (nebo n\u00ed\u017ee odpov\u011bzte ne):<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"trauma-last-24-months\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"trauma-last-24-months\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>Jste t\u011bhotn\u00e1?<\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>( Pouze pro \u017eeny )<\/small>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>Pokud ano, kolik t\u00fddn\u016f?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant-weeks\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pregnant-weeks\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\" width=\"50%\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n<!-- page 3 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Osobn\u00ed \u00fadaje\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky (3\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Zdravotn\u00ed stavy\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Dal\u0161\u00ed\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Podpis\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"table-4-choices\">\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>T\u00e9m\u011b\u0159 nikdy\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>M\u011bs\u00ed\u010dn\u00ed\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>T\u00fddenn\u00ed\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>Denn\u011b\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Bolesti hlavy nebo migr\u00e9ny\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Bolesti zad, krku a ramen\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Bolest p\u00e1nve\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Bolest kolena\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Fibromyalgie\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Alergie\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Tr\u00e1vic\u00ed probl\u00e9my\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Nevolnost\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Starosti\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Hn\u011bv\/vztek\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Smutek\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Nedostatek energie\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Nespavost\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Podr\u00e1\u017ed\u011bnost\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Deprese\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>\u00dazkost\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Z\u00e1chvaty paniky\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table> \n\n <!-- page 4 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Osobn\u00ed \u00fadaje\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Zdravotn\u00ed stav (4\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Dal\u0161\u00ed\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Podpis\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<p><strong>Pokud trp\u00edte n\u011bkter\u00fdm z n\u00e1sleduj\u00edc\u00edch stav\u016f, zvolte ano nebo ne. <\/strong>\n<\/p>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Nepravideln\u00fd krevn\u00ed tlak (vysok\u00fd nebo n\u00edzk\u00fd) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"irregular_blood_pressure\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"irregular_blood_pressure\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Hypo nebo hyperglyk\u00e9mie (l\u00e9ky)<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hypo_or_hyperglycaemic\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"hypo_or_hyperglycaemic\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Ned\u00e1vn\u00e9 operace <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recent_surgeries\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"recent_surgeries\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Nepravideln\u00e9 srde\u010dn\u00ed stavy (v\u010detn\u011b operace, kardiostimul\u00e1tor\u016f a arytmie). <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"irregular_heart_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"irregular_heart_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Z\u00e1vrat\u011b, zejm\u00e9na p\u0159i p\u0159edklonu. <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"vertigo_dizzyness\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"vertigo_dizzyness\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Psychick\u00e9 stavy (nap\u0159\u00edklad posttraumatick\u00e1 stresov\u00e1 porucha). <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychological_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"psychological_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Chronick\u00e1 bolest (fibromyalgie \/ RS) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"chronic_pain\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"chronic_pain\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Chronick\u00e1 \u00fanava (ME)<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"chronic_fatigue\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"chronic_fatigue\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>ADHD ADD <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ADHA\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ADHA\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Autismus<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Autism\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Autism\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Z\u00e1vislost<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Addiction\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Addiction\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Jin\u00e9 a dal\u0161\u00ed podrobnosti z v\u00fd\u0161e uveden\u00fdch informac\u00ed (popi\u0161te je pros\u00edm n\u00ed\u017ee)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_condition\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_condition\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><strong>D\u016eLE\u017dIT\u00c9: Pokud trp\u00edte n\u011bkter\u00fdm z n\u00e1sleduj\u00edc\u00edch onemocn\u011bn\u00ed, doporu\u010dujeme v\u00e1m spolupracovat pouze s certifikovan\u00fdmi poskytovateli TRE\u00ae, kte\u0159\u00ed maj\u00ed zku\u0161enosti s l\u00e9\u010dbou t\u011bchto onemocn\u011bn\u00ed. (Pokud m\u00e1te terapeuta nebo p\u0159\u00edtele, m\u016f\u017eete je vz\u00edt s sebou, aby se s TRE\u00ae tak\u00e9 sezn\u00e1mili, nebo v\u00e1s p\u0159i individu\u00e1ln\u00edm sezen\u00ed s TRE\u00ae podpo\u0159it). A prvn\u00edch n\u011bkolik sezen\u00ed TRE\u00ae neprov\u00e1d\u011bjte ve skupin\u011b.<\/strong>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Manick\u00e1\/depresivn\u00ed<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"manic_depressive\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"manic_depressive\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Bipol\u00e1rn\u00ed stavy<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"bipolar_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"bipolar_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Schizofrenie<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"schizophrenia\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"schizophrenia\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>T\u011b\u017ek\u00e1 deprese<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"severe_depression\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"severe_depression\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Psych\u00f3za<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychosis\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"psychosis\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Borderline personality disorder<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Borderline_personality_disorder\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Borderline_personality_disorder\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Ne<\/option><option value=\"Yes\">Ano<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<tr>\n\t<td colspan=\"2\">\n\t\t<p><label>Podrobn\u00fd popis z v\u00fd\u0161e uveden\u00fdch informac\u00ed (popi\u0161te n\u00ed\u017ee)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_condition\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_condition\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/td>\n<\/tr>\n\n<!-- page 5 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Osobn\u00ed \u00fadaje\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Zdravotn\u00ed stavy\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Ostatn\u00ed (5\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Podpis\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Jak byste na stupnici od jedn\u00e9 do deseti, p\u0159i\u010dem\u017e deset je nejintenzivn\u011bj\u0161\u00ed, ohodnotili n\u00e1sleduj\u00edc\u00ed \u010dinnosti v pr\u016fm\u011brn\u00e9m dni?<\/label>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>\u00darove\u0148 fyzick\u00e9 bolesti?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"physical_pain_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"physical_pain_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>\u00darove\u0148 emocion\u00e1ln\u00ed bolesti?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emotional_pain_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"emotional_pain_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Aktu\u00e1ln\u00ed \u00farove\u0148 stresu?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"current_stress_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"current_stress_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>M\u00e1te n\u011bjak\u00e9 dal\u0161\u00ed obavy, o kter\u00e9 byste se cht\u011bli pod\u011blit p\u0159ed n\u00e1v\u0161t\u011bvou sezen\u00ed TRE\u00ae?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_concers\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_concers\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label> M\u00e1te n\u011bjak\u00e9 dotazy k TRE? \u00ae p\u0159ed na\u0161\u00edm pl\u00e1novan\u00fdm sezen\u00edm?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_questions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_questions\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n\n<!-- page 6 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Osobn\u00ed \u00fadaje\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>V\u00edced\u00edln\u00e9 ot\u00e1zky\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Zdravotn\u00ed stavy\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Dal\u0161\u00ed\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Podpis (6\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n\n<!-- signature -->\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Napi\u0161te sv\u016fj podpis <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Tip: Pou\u017eijte kurzor my\u0161i se stisknut\u00fdm lev\u00fdm tla\u010d\u00edtkem my\u0161i a do pole napi\u0161te sv\u016fj podpis, kter\u00fdm potvrd\u00edte po\u017eadavky na zve\u0159ejn\u011bn\u00ed.<\/small>\n\t\t\t<\/p>\n\t\t\t<p><div class=\"wpcf7-form-control-signature-global-wrap\" data-field-id=\"signature-70\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:300px;height:200px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_signature-70_signature\" 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TRE\u00ae is a safe and effective stress release technique for most people. The TRE\u00ae process should not be used as a substitute for trauma recovery procedures of a medical or psychiatric\/psychological nature. 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