[{"lid":"1717161334952","ls":"10","loff":"","li_type":"nm","li_name":"name","li_title":"What\u2019s your name?","li_ph":"First Name and Last Name","li_req":"y","li_nm":"name"},{"lid":"1717162313577","ls":"20","loff":"","li_type":"em","li_name":"email","li_title":"How can we reach you?","li_ph":"Email Address","li_req":"y","li_nm":"email"},{"lid":"1717162292987","ls":"30","loff":""}]
[{"lid":"1717161564738","ls":"10","loff":"","li_type":"rd","li_name":"concern","li_title":"What\u2019s on your mind?","li_subtitle":"Select your concerns:","li_req":"y","li_variants":"Loneliness\nAnxiety\nDepression\nStress\nRelationship issues\nBurnout\nEating disorders\nPTSD\nGrief\nSleep problems\nSelf-esteem issues\nOther ","li_radcb":"cb","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"concern"}]
[{"lid":"1717161952642","ls":"10","loff":"","li_type":"sb","li_name":"country","li_title":"Select a country","li_req":"y","li_variants":"Abkhazia\nAfghanistan\nAlbania\nAlgeria\nArgentina\nArmenia\nAustralia\nAustria\nAzerbaijan\nBahamas\nBahrain\nBangladesh\nBelarus\nBelgium\nBermuda Islands\nBolivia\nBrazil\nBulgaria\nBurundi\nCambodia\nCameroon\nCanada\nChile\nChina\nColombia\nCongo\nCosta Rica\nCuba\nCyprus\nCzech Republic\nDenmark\nDominican Republic\nEcuador\nEgypt\nEl Salvador\nEstonia\nEthiopia\nFinland\nFrance\nGeorgia\nGermany\nGhana\nGibraltar\nGreat Britain \/ United Kingdom\nGreece\nGuatemala\nGuinea\nHaiti\nHawaii\nHonduras\nHong Kong\nHungary\nIceland\nIndia\nIndonesia\nIran\nIraq\nIreland\nIsrael\nItaly\nIvory Coast\nJamaica\nJapan\nKazakhstan\nKenya\nKuwait\nKyrgyzstan\nLatvia\nLebanon\nLiberia\nLibya\nLithuania\nLuxemburg\nMadagascar\nMalawi\nMalaysia\nMalta\nMexico\nMoldova\nMonaco\nMongolia\nMorocco\nNepal\nNetherlands \/ Holland\nNew Zeland\nNicaragua\nNigeria\nNorth Korea\nNorway\nOman\nPakistan\nPanama\nPapua New Guinea\nParaguay\nPeru\nPhilippines\nPoland\nPortugal\nPuerto Rico\nRomania\nRussia\nRwanda\nSaudi Arabia\nSenegal\nSierra Leone\nSingapore\nSlovakia\nSlovenia\nSouth Africa\nSouth Korea\nSouth Ossetia\nSpain\nSri Lanka\nSudan\nSweden\nSwitzerland\nSyria\nTaiwan\nTajikistan\nThailand\nTogo\nTunisia\nTurkey\nTurkmenistan\nUganda\nUkraine\nUnited Arab Emirates\nUnited States of America \/ USA\nUruguay\nUzbekistan\nVenezuela\nYemen\nZaire\nZambia\nZimbabwe","li_defselitem":"128","li_selfirstvar":"United States of America \/ USA","li_nm":"country"}]
[{"lid":"1717162155426","ls":"10","loff":"","li_type":"rd","li_name":"old","li_title":"How old are you?","li_req":"y","li_variants":"under 18 years\nover 18 years","li_radcb":"rb","li_radioposition":"1_4","li_radiowidthmobile":"y","li_nm":"old"},{"lid":"1717162524837","ls":"20","loff":"","li_type":"cb","li_req":"y","li_label":"<div style=\"font-size:14px;\" data-customstyle=\"yes\">I agree to the <a href=\"https:\/\/mariya.ai\/terms\" target=\"_blank\" style=\"color:rgb(37, 23, 14) !important;text-decoration: none;border-bottom: 1px solid rgb(37, 23, 14);box-shadow: inset 0px -0px 0px 0px rgb(37, 23, 14);-webkit-box-shadow: inset 0px -0px 0px 0px rgb(37, 23, 14);-moz-box-shadow: inset 0px -0px 0px 0px rgb(37, 23, 14);\">Terms and Conditions<\/a>. <br \/><br \/> <br \/><\/div>","li_nm":"Checkbox"}]
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