<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_16' ><form method='post' enctype='multipart/form-data' id='gform_16' action='/questionnaire/' > <div class='gform_body gform-body'><div id='gform_fields_16' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_16_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_16_1"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_16_1'> <span id='input_16_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_16_1_3' value='' aria-required='true' placeholder='First Name' /> <label for='input_16_1_3' >First</label> </span> </div></fieldset><div id="field_16_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_16_2"><label class='gfield_label' for='input_16_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_16_2' type='text' value='' class='large' placeholder='Business email address' aria-required="true" aria-invalid="false" /> </div></div><fieldset id="field_16_3" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_16_3"><legend class='gfield_label gfield_label_before_complex' >Consent<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_16_3'><div class='gchoice gchoice_16_3_1'> <input class='gfield-choice-input' name='input_3.1' type='checkbox' value='I consent to the processing and sharing with partners of the personal data that I provide Packet 6 for this activity in accordance with and as described in the &lt;a href=&quot;https://packet6.com/privacy-policy&quot; target=&quot;_new&quot;&gt;Privacy Policy&lt;/a&gt;' id='choice_16_3_1' /> <label for='choice_16_3_1' id='label_16_3_1'>I consent to the processing and sharing with partners of the personal data that I provide Packet 6 for this activity in accordance with and as described in the <a href="https://packet6.com/privacy-policy" target="_new">Privacy Policy</a></label> </div></div></div></fieldset><div id="field_16_4" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_16_4"><label class='gfield_label' for='input_16_4' >Phone</label><div class='ginput_container'><input name='input_4' id='input_16_4' type='text' value='' /></div><div class='gfield_description' id='gfield_description_16_4'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_16' class='gform_button button' value='Get the report' onclick='if(window["gf_submitting_16"]){return false;} window["gf_submitting_16"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_16"]){return false;} window["gf_submitting_16"]=true; jQuery("#gform_16").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_16' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='16' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_16' value='WyJbXSIsImY4MGVlNTA5MGVjMWYzYzU5NzUyOGFhOWE3ZGFiMzRlIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_16' id='gform_target_page_number_16' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_16' id='gform_source_page_number_16' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_2" name="ak_js" value="208"/><script>document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>