{"id":175,"date":"2024-04-25T16:16:19","date_gmt":"2024-04-25T19:16:19","guid":{"rendered":"https:\/\/cefontedavida.com.br\/?page_id=175"},"modified":"2025-12-06T10:59:29","modified_gmt":"2025-12-06T13:59:29","slug":"anamnese","status":"publish","type":"page","link":"https:\/\/cefontedavida.com.br\/index.php\/anamnese\/","title":{"rendered":"Anamnese CEFDV"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"175\" class=\"elementor elementor-175\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3e9fe7e e-flex e-con-boxed e-con e-parent\" data-id=\"3e9fe7e\" data-element_type=\"container\" data-settings=\"{&quot;container_type&quot;:&quot;flex&quot;,&quot;content_width&quot;:&quot;boxed&quot;}\" data-core-v316-plus=\"true\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ae028cc elementor-widget elementor-widget-shortcode\" data-id=\"ae028cc\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-181 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-181\" data-uid=\"6a1540ee01a27\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-181\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-181 forminator-design--material  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"181\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"material\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\tenctype=\"multipart\/form-data\"\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"6a1540ee01a27\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-pagination-progress\" aria-hidden=\"true\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-181--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-181--page-0-label\" data-step=\"0\" data-label=\"Terminar\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a1540ee01a27\" id=\"forminator-field-name-1_6a1540ee01a27-label\" class=\"forminator-label\">Seu Nome Completo <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Digite o Nome Completo\" id=\"forminator-field-name-1_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a1540ee01a27\" id=\"forminator-field-date-1-picker_6a1540ee01a27-label\" class=\"forminator-label\">Sua data de Nascimento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6a1540ee01a27\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Sua data de Nascimento\" id=\"forminator-field-date-1-picker_6a1540ee01a27\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"0\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a1540ee01a27\" id=\"forminator-field-number-1_6a1540ee01a27-label\" class=\"forminator-label\">Qual a sua Idade? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"Idade\" id=\"forminator-field-number-1_6a1540ee01a27\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a1540ee01a27\" id=\"forminator-field-name-2_6a1540ee01a27-label\" class=\"forminator-label\">Nome do Pai <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.x. John Doe\" id=\"forminator-field-name-2_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a1540ee01a27\" id=\"forminator-field-name-3_6a1540ee01a27-label\" class=\"forminator-label\">Nome da M\u00e3e <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.x. John Doe\" id=\"forminator-field-name-3_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a1540ee01a27\" id=\"forminator-field-number-2_6a1540ee01a27-label\" class=\"forminator-label\">Qual o seu RG? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"Digite sem pontos ou tra\u00e7os\" id=\"forminator-field-number-2_6a1540ee01a27\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999999999999999999999999999999999999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6a1540ee01a27\" id=\"forminator-field-number-3_6a1540ee01a27-label\" class=\"forminator-label\">Qual o seu CPF? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-3\" value=\"\" placeholder=\"Digite sem pontos ou tra\u00e7os\" id=\"forminator-field-number-3_6a1540ee01a27\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999999999999999999999999999999999999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-1_6a1540ee01a27\" id=\"forminator-form-181__field--select-1_6a1540ee01a27-label\" class=\"forminator-label\">Qual a sua Escolaridade? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-1_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"selecione apenas uma op\u00e7\u00e3o:\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-1_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-1_6a1540ee01a27-description\"><option value=\"\">selecione apenas uma op\u00e7\u00e3o:<\/option><option value=\"Ensino-Fundamental-Cursando\"  data-calculation=\"0\">Ensino Fundamental Cursando<\/option><option value=\"two\"  data-calculation=\"0\">Ensino Fundamental Completo<\/option><option value=\"Ensino-Fundamental-Incompleto\"  data-calculation=\"0\">Ensino Fundamental Incompleto<\/option><option value=\"Ensino-M\u00e9dio-Cursando\"  data-calculation=\"0\">Ensino M\u00e9dio Cursando<\/option><option value=\"one\"  data-calculation=\"0\">Ensino M\u00e9dio Completo<\/option><option value=\"Ensino-M\u00e9dica-Incompleto\"  data-calculation=\"0\">Ensino M\u00e9dio Incompleto<\/option><option value=\"Ensino-Superior-Cursando\"  data-calculation=\"0\">Ensino Superior Cursando<\/option><option value=\"Ensino-Superior-Completo\"  data-calculation=\"0\">Ensino Superior Completo<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a1540ee01a27\" id=\"forminator-field-text-1_6a1540ee01a27-label\" class=\"forminator-label\">Qual o Seu Endere\u00e7o? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"Digite o endere\u00e7o completo\" id=\"forminator-field-text-1_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a1540ee01a27\" id=\"forminator-field-text-2_6a1540ee01a27-label\" class=\"forminator-label\">Qual o Seu Bairro? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"Digite o seu Bairro\" id=\"forminator-field-text-2_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a1540ee01a27\" id=\"forminator-field-text-3_6a1540ee01a27-label\" class=\"forminator-label\">Qual cidade voc\u00ea mora? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Digite o nome da cidade\" id=\"forminator-field-text-3_6a1540ee01a27\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6a1540ee01a27\" id=\"forminator-field-number-4_6a1540ee01a27-label\" class=\"forminator-label\">Qual o seu CEP? <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-4\" value=\"\" placeholder=\"E.x. 41720420\" id=\"forminator-field-number-4_6a1540ee01a27\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"86464564684798789789899\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a1540ee01a27\" id=\"forminator-field-phone-1_6a1540ee01a27-label\" class=\"forminator-label\">Possui Telefone Fixo?<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.x. 7132468533\" id=\"forminator-field-phone-1_6a1540ee01a27\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6a1540ee01a27\" id=\"forminator-field-phone-2_6a1540ee01a27-label\" class=\"forminator-label\">Qual o seu Whatsapp? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.x. 7198899775566\" id=\"forminator-field-phone-2_6a1540ee01a27\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"br\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a1540ee01a27\" id=\"forminator-field-email-1_6a1540ee01a27-label\" class=\"forminator-label\">Qual o seu E-mai <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.x. john@doe.com\" id=\"forminator-field-email-1_6a1540ee01a27\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a1540ee01a27\" id=\"forminator-field-textarea-1_6a1540ee01a27-label\" class=\"forminator-label\">Como conheceu o Fonte da vida? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a1540ee01a27\" id=\"forminator-field-textarea-2_6a1540ee01a27-label\" class=\"forminator-label\">Foi indicado por algu\u00e9m? Se sim, quem? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a1540ee01a27\" id=\"forminator-field-textarea-3_6a1540ee01a27-label\" class=\"forminator-label\">J\u00e1 fez uso de Ayahuasca, Daime ou Vegetal alguma vez na vida? Se sim, quando? Onde? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-181--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-181--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"P\u00e1gina 1\" data-name=\"page-break-2\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12  vida-familiar\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VIDA FAMILIAR<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-2_6a1540ee01a27\" id=\"forminator-form-181__field--select-2_6a1540ee01a27-label\" class=\"forminator-label\">Estado civil ou de conviv\u00eancia <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-2_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Estado civil ou de conviv\u00eancia\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-2_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-2_6a1540ee01a27-description\"><option value=\"\">Estado civil ou de conviv\u00eancia<\/option><option value=\"one\"  data-calculation=\"0\">Solteiro(a)<\/option><option value=\"two\"  data-calculation=\"0\">Casado(a)<\/option><option value=\"Divorciado(a)\"  data-calculation=\"0\">Divorciado(a)<\/option><option value=\"Uni\u00e3o-Est\u00e1vel\"  data-calculation=\"0\">Uni\u00e3o Est\u00e1vel<\/option><option value=\"Vi\u00favo(a)\"  data-calculation=\"0\">Vi\u00favo(a)<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-25\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-25_6a1540ee01a27\" id=\"forminator-form-181__field--select-25_6a1540ee01a27-label\" class=\"forminator-label\">Tem filhos? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-25_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-25\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Tem filhos?\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-25_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-25_6a1540ee01a27-description\"><option value=\"\">Tem filhos?<\/option><option value=\"Uni\u00e3o-Est\u00e1vel\"  data-calculation=\"0\">Sim<\/option><option value=\"Vi\u00favo(a)\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a1540ee01a27\" id=\"forminator-field-textarea-4_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, quantos? Idade? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"Se sim, quantos? Idade?\" id=\"forminator-field-textarea-4_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a1540ee01a27\" id=\"forminator-field-textarea-5_6a1540ee01a27-label\" class=\"forminator-label\">Se a gente precisar falar com algu\u00e9m, quem seria? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-5\" placeholder=\"Digite o nome da pessoa:\" id=\"forminator-field-textarea-5_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a1540ee01a27\" id=\"forminator-field-phone-3_6a1540ee01a27-label\" class=\"forminator-label\">Contato de Emerg\u00eancia <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"E.x. +1 300 400 5000\" id=\"forminator-field-phone-3_6a1540ee01a27\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a1540ee01a27\" id=\"forminator-field-textarea-6_6a1540ee01a27-label\" class=\"forminator-label\">Qual grau de parentesco? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">VIDA PROFISSIONAL<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6a1540ee01a27\" id=\"forminator-field-textarea-7_6a1540ee01a27-label\" class=\"forminator-label\">Qual sua profiss\u00e3o ou no que trabalha? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Sa\u00fade e Comportamento<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-3_6a1540ee01a27\" id=\"forminator-form-181__field--select-3_6a1540ee01a27-label\" class=\"forminator-label\">Selecionar <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-3_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Como est\u00e1 seu equil\u00edbrio emocional nos \u00faltimos tempos?\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-3_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-3_6a1540ee01a27-description\"><option value=\"\">Como est\u00e1 seu equil\u00edbrio emocional nos \u00faltimos tempos?<\/option><option value=\"one\"  data-calculation=\"0\">Equilibrado<\/option><option value=\"two\"  data-calculation=\"0\">Desequilibrado<\/option><option value=\"Precisando-de-ajuda\"  data-calculation=\"0\">Precisando de ajuda<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-4_6a1540ee01a27\" id=\"forminator-form-181__field--select-4_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem plano de sa\u00fade? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-4_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Voc\u00ea tem plano de sa\u00fade?\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-4_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-4_6a1540ee01a27-description\"><option value=\"\">Voc\u00ea tem plano de sa\u00fade?<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_6a1540ee01a27\" id=\"forminator-field-textarea-8_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual:<\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-5_6a1540ee01a27\" id=\"forminator-form-181__field--select-5_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea fez alguma cirurgia recente? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-5_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Voc\u00ea fez alguma cirurgia recente?\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-5_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-5_6a1540ee01a27-description\"><option value=\"\">Voc\u00ea fez alguma cirurgia recente?<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-9_6a1540ee01a27\" id=\"forminator-field-textarea-9_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual:<\/label><textarea name=\"textarea-9\" placeholder=\"\" id=\"forminator-field-textarea-9_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-6_6a1540ee01a27\" id=\"forminator-form-181__field--select-6_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem problema de F\u00edgado? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-6_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma Op\u00e7\u00e3o:\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-6_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-6_6a1540ee01a27-description\"><option value=\"\">Selecione uma Op\u00e7\u00e3o:<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-7_6a1540ee01a27\" id=\"forminator-form-181__field--select-7_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem problema de Rim? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-7_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-7\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-7_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-7_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-8_6a1540ee01a27\" id=\"forminator-form-181__field--select-8_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem problema de Cora\u00e7\u00e3o? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-8_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o:\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-8_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-8_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o:<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-9_6a1540ee01a27\" id=\"forminator-form-181__field--select-9_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem press\u00e3o ALTA? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-9_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-9_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-9_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-10_6a1540ee01a27\" id=\"forminator-form-181__field--select-10_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem press\u00e3o BAIXA? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-10_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-10\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-10_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-10_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-11\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-11_6a1540ee01a27\" id=\"forminator-form-181__field--select-11_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea tem DIABETES? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-11_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-11\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-11_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-11_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-12\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-12_6a1540ee01a27\" id=\"forminator-form-181__field--select-12_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea j\u00e1 teve convuls\u00e3o? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-12_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-12\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-12_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-12_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-10\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-10_6a1540ee01a27\" id=\"forminator-field-textarea-10_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, quando?<\/label><textarea name=\"textarea-10\" placeholder=\"\" id=\"forminator-field-textarea-10_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-13_6a1540ee01a27\" id=\"forminator-form-181__field--select-13_6a1540ee01a27-label\" class=\"forminator-label\">J\u00e1 teve surto psic\u00f3tico? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-13_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-13\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-13_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-13_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-11\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-11_6a1540ee01a27\" id=\"forminator-field-textarea-11_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, quando?<\/label><textarea name=\"textarea-11\" placeholder=\"\" id=\"forminator-field-textarea-11_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-14\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-14_6a1540ee01a27\" id=\"forminator-form-181__field--select-14_6a1540ee01a27-label\" class=\"forminator-label\">Algum diagnostico de esquizofrenia na fam\u00edlia? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-14_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-14\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-14_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-14_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-12\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-12_6a1540ee01a27\" id=\"forminator-field-textarea-12_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, quem?<\/label><textarea name=\"textarea-12\" placeholder=\"\" id=\"forminator-field-textarea-12_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-15\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-15_6a1540ee01a27\" id=\"forminator-form-181__field--select-15_6a1540ee01a27-label\" class=\"forminator-label\">Algum problema de sa\u00fade que queira compartilhar? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-15_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-15\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Algum problema de sa\u00fade que queira compartilhar?\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-15_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-15_6a1540ee01a27-description\"><option value=\"\">Algum problema de sa\u00fade que queira compartilhar?<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-13\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-13_6a1540ee01a27\" id=\"forminator-field-textarea-13_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-13\" placeholder=\"\" id=\"forminator-field-textarea-13_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-16\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-16_6a1540ee01a27\" id=\"forminator-form-181__field--select-16_6a1540ee01a27-label\" class=\"forminator-label\">Faz uso de medica\u00e7\u00e3o TARJA PRETA PARA ANSIEDADE E DEPRESS\u00c3O? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-16_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-16\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-16_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-16_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-14\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-14_6a1540ee01a27\" id=\"forminator-field-textarea-14_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-14\" placeholder=\"\" id=\"forminator-field-textarea-14_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-17\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-17_6a1540ee01a27\" id=\"forminator-form-181__field--select-17_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea j\u00e1 teve alguma doen\u00e7a grave? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-17_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-17\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-17_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-17_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-15\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-15_6a1540ee01a27\" id=\"forminator-field-textarea-15_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-15\" placeholder=\"\" id=\"forminator-field-textarea-15_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-18\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-18_6a1540ee01a27\" id=\"forminator-form-181__field--select-18_6a1540ee01a27-label\" class=\"forminator-label\">Faz uso de \u00e1lcool diariamente? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-18_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-18\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-18_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-18_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><option value=\"Socialmente\"  data-calculation=\"0\">Socialmente<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-19\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-19_6a1540ee01a27\" id=\"forminator-form-181__field--select-19_6a1540ee01a27-label\" class=\"forminator-label\">Tem atualmente algum problema de sa\u00fade que queira compartilhar? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-19_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-19\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-19_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-19_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-16\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-16_6a1540ee01a27\" id=\"forminator-field-textarea-16_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-16\" placeholder=\"\" id=\"forminator-field-textarea-16_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-20\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-20_6a1540ee01a27\" id=\"forminator-form-181__field--select-20_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea faz uso de algum tipo de drogas? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-20_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-20\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-20_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-20_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><option value=\"Diariamente\"  data-calculation=\"0\">Diariamente<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-17\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-17_6a1540ee01a27\" id=\"forminator-field-textarea-17_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-17\" placeholder=\"\" id=\"forminator-field-textarea-17_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-181--page-2\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-181--page-2-label\" aria-hidden=\"true\" data-step=\"2\" data-label=\"P\u00e1gina 2\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Espiritualidade<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-21\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-21_6a1540ee01a27\" id=\"forminator-form-181__field--select-21_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea atualmente pratica alguma religi\u00e3o? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-21_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-21\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-21_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-21_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><option value=\"Diariamente\"  data-calculation=\"0\">As vezes<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-18\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-18_6a1540ee01a27\" id=\"forminator-field-textarea-18_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-18\" placeholder=\"\" id=\"forminator-field-textarea-18_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-22\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-22_6a1540ee01a27\" id=\"forminator-form-181__field--select-22_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea j\u00e1 teve experi\u00eancia de ver ou ouvir coisas que os outros n\u00e3o podiam ver ou ouvir? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-22_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-22\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-22_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-22_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><option value=\"Diariamente\"  data-calculation=\"0\">Diariamente<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-23\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-23_6a1540ee01a27\" id=\"forminator-form-181__field--select-23_6a1540ee01a27-label\" class=\"forminator-label\">Voc\u00ea j\u00e1 incorporou alguma vez? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-23_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-23\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-23_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-23_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-24\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-181__field--select-24_6a1540ee01a27\" id=\"forminator-form-181__field--select-24_6a1540ee01a27-label\" class=\"forminator-label\">Alguma outra informa\u00e7\u00e3o importante que queira acrescentar? <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-181__field--select-24_6a1540ee01a27\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-24\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecione uma op\u00e7\u00e3o\" data-search=\"false\" aria-labelledby=\"forminator-form-181__field--select-24_6a1540ee01a27-label\" aria-describedby=\"forminator-form-181__field--select-24_6a1540ee01a27-description\"><option value=\"\">Selecione uma op\u00e7\u00e3o<\/option><option value=\"one\"  data-calculation=\"0\">Sim<\/option><option value=\"two\"  data-calculation=\"0\">N\u00e3o<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-19\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-19_6a1540ee01a27\" id=\"forminator-field-textarea-19_6a1540ee01a27-label\" class=\"forminator-label\">Se sim, qual?<\/label><textarea name=\"textarea-19\" placeholder=\"\" id=\"forminator-field-textarea-19_6a1540ee01a27\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6a1540ee01a27\" id=\"forminator-field-consent-1_6a1540ee01a27-label\" class=\"forminator-label\">TERMO DE RESPONSABILIDADE <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label for=\"forminator-field-consent-1_6a1540ee01a27\" id=\"forminator-field-consent-1_6a1540ee01a27__label\" class=\"forminator-checkbox forminator-consent\" style=\"margin: 0;\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a1540ee01a27\" value=\"marcado\" aria-labelledby=\"forminator-field-consent-1_6a1540ee01a27-label\" aria-describedby=\"forminator-field-consent-1_6a1540ee01a27__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a1540ee01a27__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Eu, abaixo assinado, venho de livre e espont\u00e2nea vontade solicitar o ingresso \u00e0s cerim\u00f4nias espiritualistas com Ayahuasca, no Centro Espiritualista Fonte da Vida. Declaro que tomei ci\u00eancia da natureza dos trabalhos, bem como da prepara\u00e7\u00e3o exigida, dos detalhes da cerim\u00f4nia e da condi\u00e7\u00e3o expressa de permanecer na sess\u00e3o at\u00e9 o fechamento dos trabalhos, assim como da proibi\u00e7\u00e3o de portar ou usar quaisquer subst\u00e2ncias proibidas pela Legisla\u00e7\u00e3o Penal Brasileira, bebidas alco\u00f3licas, drogas il\u00edcitas, armas brancas ou de fogo, artefatos explosivos, entre outros. Declaro tamb\u00e9m que obedecerei a todas as regras da irmandade durante as cerim\u00f4nias, que contribuirei para os custos de obten\u00e7\u00e3o da Ayahuasca e da manuten\u00e7\u00e3o do Centro, atrav\u00e9s da contribui\u00e7\u00e3o a cada cerim\u00f4nia que participarei e que n\u00e3o estou suspenso com a Ayahuasca em outros centros.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a1540ee0aebd\" id=\"forminator-field-ctlSignature6a1540ee0aebd-label\" class=\"forminator-label\">Assine o seu nome completo <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"280\" aria-describedby=\"forminator-field-ctlSignature6a1540ee0aebd-description\"><span id=\"ctlSignature6a1540ee0aebd_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Igual ao do seu documento<\/span><div id=\"ctlSignature6a1540ee0aebd_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a1540ee0aebd\" class=\"forminator-signature-canvas\" height=\"280\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6a1540ee0aebd\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a1540ee01a27\" id=\"forminator-field-upload-1_6a1540ee01a27-label\" class=\"forminator-label\">Envie a foto segurando um documento de identifica\u00e7\u00e3o <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_6a1540ee01a27\" 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