{{ extends "global/Page.html" }}

{% block scripts %}
<script language="JavaScript">

    var sec = 0;

    var timer = setInterval(function () {
    document.getElementById("peq2_time").value = ((sec+=100)/1000);}, 100);

</script>
{% endblock %}



{% block title %}
    Follow-Up Questionnaire
{% endblock %}

{% block content %}
    <hr>
    <p>Please answer the following questions about yourself. There are no right or wrong answers.
    </p>
    <hr>

    <p>Safety first. </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_1 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_1" value="{{ forloop.counter}}"
                    id="id_risk_1_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_1 %}
            <td align="center" width="9%"><label for="id_risk_1_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <p>I do not take risks with my health. </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_2 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_2" value="{{ forloop.counter}}"
                    id="id_risk_2_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_2 %}
            <td align="center" width="9%"><label for="id_risk_2_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <p>I prefer to avoid risks. </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_3 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_3" value="{{ forloop.counter}}"
                    id="id_risk_3_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_3 %}
            <td align="center" width="9%"><label for="id_risk_3_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>


    <p>I take risks regularly. </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_4 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_4" value="{{ forloop.counter}}"
                    id="id_risk_4_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_4 %}
            <td align="center" width="9%"><label for="id_risk_4_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <p>I really dislike not knowing what is going to happen.</p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_5 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_5" value="{{ forloop.counter}}"
                    id="id_risk_5_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_5 %}
            <td align="center" width="9%"><label for="id_risk_5_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <p>I usually view risks as a challenge. </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_6 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_6" value="{{ forloop.counter}}"
                    id="id_risk_6_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_6 %}
            <td align="center" width="9%"><label for="id_risk_6_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <p>I view myself as: </p>
    <div class="indented">
    <table width="100%" border="1" bordercolor="#e3e3e3" cellpadding="2">
    <tr>
        {% for radio in form.risk_7 %}
            <td align="center" valign="top" width="9%"><input type="radio" name="risk_7" value="{{ forloop.counter}}"
                    id="id_risk_7_{{ forloop.counter0 }}" required /></td>
        {% endfor %}
    </tr>
    <tr>
        {% for radio in form.risk_7 %}
            <td align="center" width="9%"><label for="id_risk_7_{{ forloop.counter0 }}">{{ radio.label }}</label></td>
        {% endfor %}
    </tr>
    </table></div>
    <br>

    <hr>

    {% next_button %}
    <input type="hidden" id="peq2_time" name="peq2_time">

{% endblock %}

{% block styles %}
    <STYLE TYPE="text/css">
        .indented { padding-left: 50pt; padding-right: 50pt; font-weight: normal !important;}
        .tabmarg {margin-left: 80px}
        .tabmarg2 {margin-left: 30px}
        label {font-weight: normal !important;}
                td {
          border-width: 1px ;
            }
    </STYLE>
{% endblock %}