{"id":474,"date":"2020-11-16T14:16:42","date_gmt":"2020-11-16T14:16:42","guid":{"rendered":"https:\/\/yaelrotstein.co.il\/?page_id=474"},"modified":"2020-11-18T14:08:41","modified_gmt":"2020-11-18T14:08:41","slug":"%d7%a9%d7%90%d7%9c%d7%95%d7%9f-%d7%91%d7%a8%d7%99%d7%90%d7%95%d7%aa","status":"publish","type":"page","link":"https:\/\/yaelrotstein.co.il\/?page_id=474","title":{"rendered":"\u05e9\u05d0\u05dc\u05d5\u05df \u05d1\u05e8\u05d9\u05d0\u05d5\u05ea"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"474\" class=\"elementor elementor-474\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7c363adf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7c363adf\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7216c9d4\" data-id=\"7216c9d4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-22579718 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"22579718\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-808c7ae\" data-id=\"808c7ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7caf6f3a elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"7caf6f3a\" data-element_type=\"widget\" data-widget_type=\"theme-post-title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">\u05e9\u05d0\u05dc\u05d5\u05df \u05d1\u05e8\u05d9\u05d0\u05d5\u05ea<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0fb937f elementor-widget elementor-widget-shortcode\" data-id=\"0fb937f\" 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\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f477-o1\" lang=\"he-IL\" dir=\"rtl\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F474#wpcf7-f477-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"477\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"he_IL\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f477-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"firstSec\">\n\t<p>\u05e9\u05d0\u05dc\u05d5\u05df \u05d1\u05e8\u05d9\u05d0\u05d5\u05ea- \u05d4\u05e4\u05e8\u05d8\u05d9\u05dd \u05de\u05d5\u05d2\u05e0\u05d9\u05dd \u05d1\u05e1\u05d5\u05d3\u05d9\u05d5\u05ea \u05e8\u05e4\u05d5\u05d0\u05d9\u05ea \u05e2\u05dc \u05e4\u05d9 \u05d7\u05d5\u05e7 -\u05ea\u05d0\u05e8\u05d9\u05da: <span class=\"wpcf7-form-control-wrap\" data-name=\"creatdate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"creatdate\" \/><\/span><br \/>\n\u05e4\u05e8\u05d8\u05d9\u05dd \u05db\u05dc\u05dc\u05d9\u05d9\u05dd<br \/>\n\u05e9\u05dd: <span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> \u05d4\u05e4\u05e0\u05d9\u05d9\u05d4 \u05e2\"\u05d9: <span class=\"wpcf7-form-control-wrap\" data-name=\"fromname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"fromname\" \/><\/span><br \/>\n\u05db\u05ea\u05d5\u05d1\u05ea: <span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span> \u05de\u05e7\u05e6\u05d5\u05e2\/\u05e2\u05d9\u05e1\u05d5\u05e7: <span class=\"wpcf7-form-control-wrap\" data-name=\"profession\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"profession\" \/><\/span><br \/>\n\u05ea\u05d0\u05e8\u05d9\u05da \u05dc\u05d9\u05d3\u05d4\/\u05d2\u05d9\u05dc: <span class=\"wpcf7-form-control-wrap\" data-name=\"birthday\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birthday\" \/><\/span> \u05de\u05e7\u05d5\u05dd \u05e2\u05d1\u05d5\u05d3\u05d4: <span class=\"wpcf7-form-control-wrap\" data-name=\"workplace\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"workplace\" \/><\/span><br \/>\n\u05d8\u05dc\u05e4\u05d5\u05df \u05d1\u05d1\u05d9\u05ea: <span class=\"wpcf7-form-control-wrap\" data-name=\"homephone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"homephone\" \/><\/span> \u05d8\u05dc\u05e4\u05d5\u05df \u05d1\u05e2\u05d1\u05d5\u05d3\u05d4:\u00a0 <span class=\"wpcf7-form-control-wrap\" data-name=\"workphone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"workphone\" \/><\/span> \u05e0\u05d9\u05d9\u05d3: <span class=\"wpcf7-form-control-wrap\" data-name=\"mobile\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"mobile\" \/><\/span><br \/>\n\u05de\u05e6\u05d1 \u05de\u05e9\u05e4\u05d7\u05ea\u05d9: <span class=\"wpcf7-form-control-wrap\" data-name=\"status\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"status\" \/><\/span> \u05d0\u05e8\u05e5 \u05dc\u05d9\u05d3\u05d4: <span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span><br \/>\n\u05d0\u05d9-\u05de\u05d9\u05d9\u05dc: <span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><br \/>\n\u05e1\u05d9\u05d1\u05d5\u05ea \u05e2\u05d9\u05e7\u05e8\u05d9\u05d5\u05ea \u05dc\u05e7\u05d1\u05d9\u05e2\u05ea \u05e4\u05d2\u05d9\u05e9\u05d4 \u05d6\u05d5:<br \/>\n1. <span class=\"wpcf7-form-control-wrap\" data-name=\"cause-1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cause-1\" \/><\/span><br \/>\n2. <span class=\"wpcf7-form-control-wrap\" data-name=\"cause-2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cause-2\" \/><\/span><br \/>\n3. <span class=\"wpcf7-form-control-wrap\" data-name=\"cause-3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cause-3\" \/><\/span>\n\t<\/p>\n<\/div>\n<p>\u05e2\u05d1\u05e8 \u05e8\u05e4\u05d5\u05d0\u05d9: \u05d1\u05d1\u05e7\u05e9\u05d4 \u05e1\u05de\u05df\/\u05d9 \u05d1 \u2013 V \u05ea\u05d7\u05ea '\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0' \u2013 \u05d0\u05dd \u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0 \u05d7\u05d5\u05d5\u05d9\u05ea \u05d0\u05ea \u05d4\u05d1\u05e2\u05d9\u05d4, \u05ea\u05d7\u05ea '\u05d1\u05e2\u05d1\u05e8' \u2013 \u05d0\u05dd \u05e1\u05d1\u05dc\u05ea \u05de\u05d4\u05d1\u05e2\u05d9\u05d4 \u05d1\u05e2\u05d1\u05e8 \u05d5\u05ea\u05d7\u05ea '\u05d1\u05d4\u05d5\u05d5\u05d4' \u2013 \u05d0\u05dd \u05d0\u05ea\/\u05d4 \u05e1\u05d5\u05d1\u05dc\/\u05ea \u05de\u05d4\u05d1\u05e2\u05d9\u05d4 \u05db\u05e2\u05ea. \u05d0\u05dd \u05d0\u05d9\u05e0\u05da \u05d1\u05d8\u05d5\u05d7\/\u05d4 \u05d4\u05e9\u05d0\u05d9\u05e8\/\u05d9 \u05e8\u05d9\u05e7.\n<\/p>\n<div class=\"alerg\">\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d0\u05dc\u05e8\u05d2\u05d9\u05d5\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po1\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po1\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po1\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po1\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d0\u05e4\u05e0\u05d3\u05d9\u05e6\u05d9\u05d8 \/ \u05d3\u05dc\u05e7\u05ea \u05d4\u05ea\u05d5\u05e1\u05e4\u05ea\u05df - <span class=\"wpcf7-form-control-wrap\" data-name=\"po2\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po2\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po2\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po2\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d0\u05e1\u05d8\u05de\u05d4 \/ \u05d1\u05e8\u05d5\u05e0\u05db\u05d9\u05d8\u05d9\u05e1 \u05e1\u05e4\u05e1\u05d8\u05d9\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po3\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po3\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po3\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po3\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05db\u05dc\u05d9 \u05d3\u05dd - <span class=\"wpcf7-form-control-wrap\" data-name=\"po4\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po4\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po4\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po4\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e1\u05e8\u05d8\u05df \u05de\u05db\u05dc \u05e1\u05d5\u05d2 \u05e9\u05d4\u05d5\u05d0 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po5\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po5\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po5\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po5\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e1\u05d5\u05db\u05e8\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po6\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po6\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po6\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po6\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05d9\u05e4\u05d5\u05d2\u05dc\u05d9\u05e7\u05de\u05d9\u05d4 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po7\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po7\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po7\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po7\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05de\u05d5\u05e9 \u05d1\u05e1\u05de\u05d9\u05dd - <span class=\"wpcf7-form-control-wrap\" data-name=\"po8\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po8\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po8\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po8\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d0\u05e4\u05d9\u05dc\u05e4\u05e1\u05d9\u05d4 \/ \u05d4\u05ea\u05db\u05d5\u05d5\u05e6\u05d5\u05d9\u05d5\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po9\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po9\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po9\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po9\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05db\u05d9\u05e1 \u05d4\u05de\u05e8\u05d4 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po10\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po10\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po10\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po10\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d2\u05d0\u05d5\u05d8 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po11\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po11\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po11\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po11\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d7\u05dc\u05ea \u05dc\u05d1 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po12\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po12\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po12\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po12\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d8\u05d7\u05d5\u05e8\u05d9\u05dd - <span class=\"wpcf7-form-control-wrap\" data-name=\"po13\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po13\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po13\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po13\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05dc\u05d7\u05e5 \u05d3\u05dd \u05d2\u05d1\u05d5\u05d4 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po14\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po14\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po14\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po14\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d7\u05dc\u05ea \u05db\u05dc\u05d9\u05d5\u05ea \/ \u05d0\u05d1\u05e0\u05d9 \u05db\u05dc\u05d9\u05d5\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po15\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po15\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po15\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po15\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d7\u05dc\u05ea \u05db\u05d1\u05d3 \/ \u05d3\u05dc\u05e7\u05ea \u05db\u05d1\u05d3 (Hepatitis) - <span class=\"wpcf7-form-control-wrap\" data-name=\"po16\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po16\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po16\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po16\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d3\u05dc\u05e7\u05ea \u05e9\u05d9\u05d2\u05e8\u05d5\u05df (Rheumatic Fever) - <span class=\"wpcf7-form-control-wrap\" data-name=\"po17\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po17\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po17\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po17\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d1\u05e5 \u05de\u05d5\u05d7 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po18\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po18\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po18\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po18\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e9\u05ea\u05dc\u05ea \u05d0\u05d9\u05d1\u05e8\u05d9\u05dd - <span class=\"wpcf7-form-control-wrap\" data-name=\"po19\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po19\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po19\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po19\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d7\u05dc\u05d5\u05ea \u05de\u05d9\u05df - <span class=\"wpcf7-form-control-wrap\" data-name=\"po20\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po20\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po20\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po20\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d7\u05dc\u05d5\u05ea \u05d1\u05dc\u05d5\u05d8\u05ea \u05d4\u05ea\u05e8\u05d9\u05e1 \/ \u05d4\u05ea\u05d9\u05e8\u05d5\u05d0\u05d9\u05d3 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po21\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po21\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po21\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po21\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d7\u05e4\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po22\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po22\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po22\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po22\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d9\u05d1 \u05e7\u05d9\u05d1\u05d4 \/ \u05ea\u05e8\u05e1\u05e8\u05d9\u05d5\u05df \/ \u05d0\u05d5\u05dc\u05e7\u05d5\u05e1 - <span class=\"wpcf7-form-control-wrap\" data-name=\"po23\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po23\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po23\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po23\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05de\u05d9\u05d2\u05e8\u05e0\u05d5\u05ea - <span class=\"wpcf7-form-control-wrap\" data-name=\"po24\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po24\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po24\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po24\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05d1\u05dc\u05d5\u05d8\u05ea \u05d4\u05e2\u05e8\u05de\u05d5\u05e0\u05d9\u05ea (\u05e4\u05e8\u05d5\u05e1\u05d8\u05d8\u05d4) - <span class=\"wpcf7-form-control-wrap\" data-name=\"po25\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po25\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po25\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po25\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05ea\u05d7\u05d5\u05e9\u05d5\u05ea \u05d5\/\u05d0\u05d5 \u05d1\u05e2\u05d9\u05db\u05d5\u05dc \u05db\u05ea\u05d5\u05e6\u05d0\u05d4 \u05de\u05d0\u05db\u05d9\u05dc\u05ea \u05de\u05d6\u05d5\u05df \u05de\u05e1\u05d5\u05d9\u05dd - <span class=\"wpcf7-form-control-wrap\" data-name=\"po26\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d1\u05d4\u05d5\u05d5\u05d4<\/span><input type=\"checkbox\" name=\"po26\" value=\"\u05d1\u05d4\u05d5\u05d5\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05d1\u05e2\u05d1\u05e8<\/span><input type=\"checkbox\" name=\"po26\" value=\"\u05d1\u05e2\u05d1\u05e8\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0<\/span><input type=\"checkbox\" name=\"po26\" value=\"\u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"afirst\">\n\t\t<p>\u05d0\u05d7\u05e8\u05d9\u05dd: <span class=\"wpcf7-form-control-wrap\" data-name=\"elseproblems\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"elseproblems\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n<\/div>\n<p>\u05d1\u05e2\u05d1\u05e8 \u05d1\u05d4\u05d5\u05d5\u05d4 \u05de\u05e2\u05d5\u05dc\u05dd \u05dc\u05d0 \u05d1\u05d1\u05e7\u05e9\u05d4 \u05e1\u05de\u05df\/\u05d9 \u05d1 \u2013 V \u05ea\u05d7\u05ea '\u05db\u05df' \u2013 \u05d0\u05dd \u05d7\u05d5\u05d5\u05d9\u05ea \u05d0\u05ea \u05d4\u05e1\u05d9\u05de\u05e4\u05d8\u05d5\u05dd\/\u05d4\u05d4\u05e8\u05d2\u05e9\u05d4 \u05d1 \u2013 30 \u05d4\u05d9\u05de\u05d9\u05dd \u05d4\u05d0\u05d7\u05e8\u05d5\u05e0\u05d9\u05dd \u05d5\u05ea\u05d7\u05ea '\u05dc\u05d0' \u2013 \u05d0\u05dd \u05dc\u05d0 \u05d7\u05d5\u05d5\u05d9\u05ea \u05d0\u05ea \u05d4\u05e1\u05d9\u05de\u05e4\u05d8\u05d5\u05dd\/\u05d4\u05d4\u05e8\u05d2\u05e9\u05d4 \u05d1 \u2013 30 \u05d4\u05d9\u05de\u05d9\u05dd \u05d4\u05d0\u05d7\u05e8\u05d5\u05e0\u05d9\u05dd. \u05d0\u05dd \u05d0\u05d9\u05e0\u05da \u05d1\u05d8\u05d5\u05d7\/\u05d4 \u05d4\u05e9\u05d0\u05d9\u05e8\/\u05d9 \u05e8\u05d9\u05e7.\n<\/p>\n<div class=\"yesNo\">\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05de\u05e9\u05e7\u05dc <span class=\"wpcf7-form-control-wrap\" data-name=\"pt1\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt1\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt1\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05ea\u05d0\u05d1\u05d5\u05df \/ \u05d1\u05e6\u05d9\u05de\u05d0\u05d5\u05df <span class=\"wpcf7-form-control-wrap\" data-name=\"pt2\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt2\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt2\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d0\u05d9 \u05e1\u05d1\u05d9\u05dc\u05d5\u05ea \u05dc\u05d7\u05d5\u05dd \u05d0\u05d5 \u05e7\u05d5\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt3\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt3\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt3\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d7\u05d5\u05dd, \u05e6\u05de\u05e8\u05de\u05d5\u05e8\u05ea, \u05d4\u05d6\u05e2\u05d5\u05ea \u05dc\u05d9\u05dc\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt4\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt4\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt4\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05de\u05ea\u05df \u05e9\u05ea\u05df \/ \u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05db\u05de\u05d5\u05ea \u05d4\u05e9\u05ea\u05df <span class=\"wpcf7-form-control-wrap\" data-name=\"pt5\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt5\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt5\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e1\u05d7\u05e8\u05d7\u05d5\u05e8\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt6\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt6\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt6\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05e8\u05d0\u05d9\u05d9\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt7\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt7\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt7\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05ea\u05e2\u05dc\u05e4\u05d5\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt8\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt8\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt8\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1 \u05d1\u05d8\u05df \u05d0\u05d5 \u05d0\u05d9-\u05e0\u05d5\u05d7\u05d5\u05ea \u05d1\u05d1\u05d8\u05df <span class=\"wpcf7-form-control-wrap\" data-name=\"pt9\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt9\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt9\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05e2\u05d9\u05db\u05d5\u05dc, \u05e6\u05e8\u05d1\u05ea, \u05d2\u05d6\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"pt10\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt10\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt10\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05dc\u05e9\u05d5\u05dc \u05d0\u05d5 \u05e6\u05d5\u05d0\u05d4 \u05de\u05d9\u05de\u05d9\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt11\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt11\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt11\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e7\u05d0\u05d4 \u05d3\u05de\u05d9\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt12\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt12\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt12\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e2\u05e6\u05d9\u05e8\u05d5\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt13\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt13\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt13\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d3\u05dd \u05d1\u05e6\u05d5\u05d0\u05d4 \u05d0\u05d5 \u05d1\u05e9\u05ea\u05df \/ \u05e6\u05d5\u05d0\u05d4 \u05e9\u05d7\u05d5\u05e8\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt14\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt14\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt14\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05e9\u05d9\u05e0\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt15\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt15\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt15\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05de\u05e6\u05d1 \u05d4\u05e8\u05d5\u05d7, \u05de\u05ea\u05d7, \u05d3\u05d9\u05db\u05d0\u05d5\u05df, \u05d7\u05e8\u05d3\u05d4 \u05d5\u05db\u05d5' <span class=\"wpcf7-form-control-wrap\" data-name=\"pt16\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt16\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt16\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05d1\u05d9\u05ea \/ \u05d1\u05de\u05e9\u05e4\u05d7\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt17\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt17\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt17\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05e2\u05d1\u05d5\u05d3\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt18\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt18\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt18\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e7\u05e9\u05d9\u05d9\u05dd \u05d1\u05d0\u05d9\u05e0\u05d8\u05d9\u05de\u05d9\u05d5\u05ea \u05de\u05d9\u05e0\u05d9\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt19\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt19\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt19\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05e9\u05de\u05d9\u05e2\u05d4 \/ \u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05d0\u05d5\u05d6\u05e0\u05d9\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"pt20\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt20\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt20\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05e1\u05d9\u05e0\u05d5\u05e1\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"pt21\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt21\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt21\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05d1\u05d1\u05dc\u05d9\u05e2\u05d4 \/ \u05d1\u05d2\u05e8\u05d5\u05df <span class=\"wpcf7-form-control-wrap\" data-name=\"pt22\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt22\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt22\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e9\u05d9\u05e2\u05d5\u05dc \u05d9\u05ea\u05e8, \u05e2\u05d9\u05d8\u05d5\u05e9 \u05d9\u05ea\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt23\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt23\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt23\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d3\u05dd \u05d1\u05db\u05d9\u05d7 \/ \u05d1\u05dc\u05d9\u05d7\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt24\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt24\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt24\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05e0\u05e9\u05d9\u05de\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt25\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt25\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt25\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1, \u05dc\u05d7\u05e5 \u05d0\u05d5 \u05d0\u05d9 \u05e0\u05d5\u05d7\u05d5\u05ea \u05d1\u05d7\u05d6\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt26\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt26\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt26\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e2\u05d5\u05ea \u05d1\u05d3\u05d5\u05e4\u05e7 \/ \u05d1\u05e7\u05e6\u05d1 \u05d4\u05dc\u05d1 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt27\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt27\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt27\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05e0\u05e4\u05d9\u05d7\u05d5\u05ea \u05d0\u05d5 \u05db\u05d0\u05d1 \u05d1\u05e4\u05e8\u05e7\u05d9\u05dd \/ \u05d1\u05d9\u05d3\u05d9\u05d9\u05dd \/ \u05d1\u05d1\u05e8\u05db\u05d9\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"pt28\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt28\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt28\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05e2\u05d5\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt29\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt29\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt29\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1\u05d9 \u05e8\u05d0\u05e9 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt30\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt30\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt30\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05e6\u05d5\u05d5\u05d0\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt31\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt31\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt31\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1 \u05d2\u05d1 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt32\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt32\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt32\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d7\u05d5\u05dc\u05e9\u05d4, \u05d7\u05d5\u05e1\u05e8 \u05d0\u05e0\u05e8\u05d2\u05d9\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt33\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt33\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt33\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d3\u05d9\u05de\u05d5\u05dd \u05d0\u05d5 \u05e1\u05d9\u05de\u05e0\u05d9 \u05d7\u05d1\u05dc\u05d5\u05ea \u05d4\u05de\u05d5\u05e4\u05d9\u05e2\u05d9\u05dd \u05d1\u05e7\u05dc\u05d5\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"pt34\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt34\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt34\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d1\u05e2\u05d9\u05d5\u05ea \u05d1\u05d4\u05dc\u05d9\u05db\u05d4, \u05d1\u05d9\u05e9\u05d9\u05d1\u05d4, \u05d1\u05e9\u05db\u05d9\u05d1\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt35\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt35\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt35\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1\u05d9\u05dd \u05d1\u05e9\u05d3, \u05e8\u05d2\u05d9\u05e9\u05d5\u05ea, \u05d4\u05e4\u05e8\u05e2\u05d5\u05ea, \u05d2\u05d5\u05e9\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"pt36\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt36\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt36\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05db\u05d0\u05d1 \u05d1\u05d0\u05d2\u05df \/ \u05d2\u05d5\u05e9 \u05d1\u05d0\u05d2\u05df <span class=\"wpcf7-form-control-wrap\" data-name=\"pt37\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt37\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt37\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:1px solid #ccc;\">\n\t\t<p>\u05d4\u05e4\u05e8\u05e9\u05d4 \u05e0\u05e8\u05ea\u05d9\u05e7\u05d9\u05ea, \u05d0\u05d9 \u05e0\u05d5\u05d7\u05d5\u05ea, \u05e8\u05d9\u05d7 \u05e8\u05e2 <span class=\"wpcf7-form-control-wrap\" data-name=\"pt38\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt38\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt38\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n\t<div class=\"ptYes\" style=\"border-bottom:0px solid #ccc;\">\n\t\t<p>\u05d0\u05d7\u05e8\u05d9\u05dd: <span class=\"wpcf7-form-control-wrap\" data-name=\"pt39\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><input type=\"checkbox\" name=\"pt39\" value=\"\u05dc\u05d0\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><input type=\"checkbox\" name=\"pt39\" value=\"\u05db\u05df\" \/><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"ptelse\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ptelse\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"clearfix\">\n\t<\/div>\n<\/div>\n<p><strong>\u05d0\u05e9\u05e4\u05d5\u05d6\u05d9\u05dd:<\/strong><br \/>\n\u05d1\u05d1\u05e7\u05e9\u05d4 \u05de\u05e0\u05d4\/\u05d9 \u05d0\u05e9\u05e4\u05d5\u05d6\u05d9\u05dd \u05d1\u05d1\u05ea\u05d9-\u05d7\u05d5\u05dc\u05d9\u05dd<br \/>\n\u05e1\u05d9\u05d1\u05ea \u05d4\u05d0\u05e9\u05e4\u05d5\u05d6: <span class=\"wpcf7-form-control-wrap\" data-name=\"sibatishpuz\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sibatishpuz\" \/><\/span> \u05d2\u05d9\u05dc: <span class=\"wpcf7-form-control-wrap\" data-name=\"gilishpuz\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"gilishpuz\" \/><\/span>\n<\/p>\n<p><strong>\u05ea\u05e8\u05d5\u05e4\u05d5\u05ea:<\/strong><br \/>\n\u05d1\u05d1\u05e7\u05e9\u05d4 \u05de\u05e0\u05d4\/\u05d9 \u05d0\u05ea \u05db\u05dc \u05d4\u05ea\u05e8\u05d5\u05e4\u05d5\u05ea \u05d0\u05e9\u05e8 \u05dc\u05e7\u05d7\u05ea \u05e2\u05db\u05e9\u05d9\u05d5 \u05d0\u05d5 \u05d1\u05d7\u05d5\u05d3\u05e9 \u05d4\u05d0\u05d7\u05e8\u05d5\u05df \u05d5\u05db\u05df \u05d0\u05ea \u05d4\u05de\u05d9\u05e0\u05d5\u05df \u05d1\u05de\u05d9\u05d3\u05d4 \u05d5\u05d9\u05d3\u05d5\u05e2 (\u05db\u05d5\u05dc\u05dc \u05ea\u05e8\u05d5\u05e4\u05d5\u05ea \u05dc\u05dc\u05d0 \u05de\u05e8\u05e9\u05dd \u05db\u05d2\u05d5\u05df \u05d0\u05e7\u05de\u05d5\u05dc, \u05d0\u05e1\u05e4\u05d9\u05e8\u05d9\u05df, \u05d2\u05dc\u05d5\u05dc\u05d4 \u05dc\u05de\u05e0\u05d9\u05e2\u05ea \u05d4\u05e8\u05d9\u05d5\u05df, \u05d5\u05d9\u05d8\u05de\u05d9\u05e0\u05d9\u05dd, \u05de\u05d9\u05e0\u05e8\u05dc\u05d9\u05dd, \u05e6\u05de\u05d7\u05d9 \u05de\u05e8\u05e4\u05d0, \u05d4\u05d5\u05de\u05d0\u05d5\u05e4\u05ea\u05d9\u05d4 \u05d5\u05db\u05d5'):<br \/>\n1. <span class=\"wpcf7-form-control-wrap\" data-name=\"trufa1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"trufa1\" \/><\/span><br \/>\n2. <span class=\"wpcf7-form-control-wrap\" data-name=\"trufa2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"trufa2\" \/><\/span><br \/>\n3. <span class=\"wpcf7-form-control-wrap\" data-name=\"trufa3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"trufa3\" \/><\/span><br \/>\n4. <span class=\"wpcf7-form-control-wrap\" data-name=\"trufa5\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"trufa5\" \/><\/span>\n<\/p>\n<p><strong>\u05d0\u05dc\u05e8\u05d2\u05d9\u05d5\u05ea \u05d5\u05e8\u05d2\u05d9\u05e9\u05d5\u05d9\u05d5\u05ea:<\/strong><br \/>\n\u05d1\u05d1\u05e7\u05e9\u05d4 \u05de\u05e0\u05d4\/\u05d9 \u05d0\u05dc\u05e8\u05d2\u05d9\u05d5\u05ea \u05dc\u05ea\u05e8\u05d5\u05e4\u05d5\u05ea \/ \u05dc\u05de\u05d6\u05d5\u05e0\u05d5\u05ea \/ \u05dc\u05de\u05e9\u05d4\u05d5 \u05d0\u05d7\u05e8: <span class=\"wpcf7-form-control-wrap\" data-name=\"alergiaregishut\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"alergiaregishut\"><\/textarea><\/span>\n<\/p>\n<p><strong>\u05de\u05d9\u05d3\u05e2 \u05e0\u05d5\u05e1\u05e3:<\/strong><br \/>\n\u05de\u05e9\u05e7\u05dc \u05e0\u05d5\u05db\u05d7\u05d9 <span class=\"wpcf7-form-control-wrap\" data-name=\"meshkalnow\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"meshkalnow\" \/><\/span> \u05de\u05e9\u05e7\u05dc \u05e8\u05e6\u05d5\u05d9 <span class=\"wpcf7-form-control-wrap\" data-name=\"meshakwant\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"meshakwant\" \/><\/span> \u05d2\u05d5\u05d1\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"height\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"height\" \/><\/span>\u05e2\u05d9\u05e9\u05d5\u05df \u05d1\u05d4\u05d5\u05d5\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"smoke\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"smoke\" \/><\/span> \u05de\u05e1\u05e4\u05e8 \u05e1\u05d9\u05d2\u05e8\u05d9\u05d5\u05ea \u05dc\u05d9\u05d5\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"signum\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"signum\" \/><\/span> \u05d1\u05e2\u05d1\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"signumpast\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"signumpast\" \/><\/span> \u05de\u05ea\u05d9 \u05d4\u05d5\u05e4\u05e1\u05e7 <span class=\"wpcf7-form-control-wrap\" data-name=\"endsmoke\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"endsmoke\" \/><\/span>\u05e9\u05ea\u05d9\u05d9\u05ea \u05d0\u05dc\u05db\u05d5\u05d4\u05d5\u05dc <span class=\"wpcf7-form-control-wrap\" data-name=\"drink\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"drink\" \/><\/span> \u05db\u05de\u05d5\u05ea \u05e9\u05d1\u05d5\u05e2\u05d9\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"dnum\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"dnum\" \/><\/span>\u05d9\u05e6\u05d9\u05d0\u05d5\u05ea: \u05db\u05de\u05d4 \u05e4\u05e2\u05de\u05d9\u05dd \u05d1\u05d9\u05d5\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"numout\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"numout\" \/><\/span> \u05d0\u05d5 \u05d1\u05e9\u05d1\u05d5\u05e2 <span class=\"wpcf7-form-control-wrap\" data-name=\"numoutweek\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"numoutweek\" \/><\/span><br \/>\n\u05de\u05e8\u05e7\u05dd \u05e0\u05d5\u05d8\u05d4 \u05dc:<span class=\"wpcf7-form-control-wrap\" data-name=\"po27\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05e0\u05d5\u05d6\u05dc\u05d9<\/span><input type=\"checkbox\" name=\"po27\" value=\"\u05e0\u05d5\u05d6\u05dc\u05d9\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05e8\u05da<\/span><input type=\"checkbox\" name=\"po27\" value=\"\u05e8\u05da\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05de\u05d5\u05e6\u05e7<\/span><input type=\"checkbox\" name=\"po27\" value=\"\u05de\u05d5\u05e6\u05e7\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05e7\u05e9\u05d4<\/span><input type=\"checkbox\" name=\"po27\" value=\"\u05e7\u05e9\u05d4\" \/><\/span><\/span><\/span>\n<\/p>\n<p>\u05ea\u05e0\u05d5\u05e2\u05d4\/\u05e4\u05e2\u05d9\u05dc\u05d5\u05ea \u05d2\u05d5\u05e4\u05e0\u05d9\u05ea: \u05e1\u05d5\u05d2 \u05d4\u05e4\u05e2\u05d9\u05dc\u05d5\u05ea <span class=\"wpcf7-form-control-wrap\" data-name=\"sportype\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sportype\" \/><\/span> \u05de\u05e1\u05e4\u05e8 \u05e4\u05e2\u05de\u05d9\u05dd \u05d1\u05e9\u05d1\u05d5\u05e2 <span class=\"wpcf7-form-control-wrap\" data-name=\"numsportweek\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"numsportweek\" \/><\/span> \u05de\u05e1\u05e4\u05e8 \u05d3\u05e7\u05d5\u05ea \/ \u05e9\u05e2\u05d5\u05ea \u05db\u05dc \u05e4\u05e2\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"sportitme\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"sportitme\" \/><\/span>\u05de\u05e1\u05e4\u05e8 \u05e9\u05e2\u05d5\u05ea \u05e9\u05d9\u05e0\u05d4 \u05d1\u05dc\u05d9\u05dc\u05d4 \u05de\u05de\u05d5\u05e6\u05e2 <span class=\"wpcf7-form-control-wrap\" data-name=\"sleephour\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"sleephour\" \/><\/span><br \/>\n\u05d4\u05d0\u05dd \u05d0\u05ea\/\u05d4 \u05de\u05ea\u05e2\u05d5\u05e8\u05e8\/\u05ea \u05d1\u05d1\u05d5\u05e7\u05e8 \u05e8\u05e2\u05e0\u05df\/\u05d4 ? \u05e2\u05d9\u05d9\u05e3\/\u05d4 ? <span class=\"wpcf7-form-control-wrap\" data-name=\"morning\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"morning\" \/><\/span><br \/>\n\u05d4\u05e2\u05d3\u05e4\u05d4 \u05d0\u05d9\u05e9\u05d9\u05ea:<br \/>\n\u05de\u05d6\u05d2 \u05d0\u05d5\u05d9\u05e8 <span class=\"wpcf7-form-control-wrap\" data-name=\"po28\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d7\u05d5\u05dd<\/span><input type=\"checkbox\" name=\"po28\" value=\"\u05d7\u05d5\u05dd\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05e7\u05d5\u05e8<\/span><input type=\"checkbox\" name=\"po28\" value=\"\u05e7\u05d5\u05e8\" \/><\/span><\/span><\/span><br \/>\n\u05e2\u05d5\u05e0\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"po29\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05e7\u05d9\u05e5<\/span><input type=\"checkbox\" name=\"po29\" value=\"\u05e7\u05d9\u05e5\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05d7\u05d5\u05e8\u05e3<\/span><input type=\"checkbox\" name=\"po29\" value=\"\u05d7\u05d5\u05e8\u05e3\" \/><\/span><\/span><\/span><br \/>\n\u05e9\u05ea\u05d9\u05d9\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"po30\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">\u05d7\u05de\u05d4<\/span><input type=\"checkbox\" name=\"po30\" value=\"\u05d7\u05de\u05d4\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">\u05e7\u05e8\u05d4<\/span><input type=\"checkbox\" name=\"po30\" value=\"\u05e7\u05e8\u05d4\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">\u05e4\u05d5\u05e9\u05e8\u05ea<\/span><input type=\"checkbox\" name=\"po30\" value=\"\u05e4\u05d5\u05e9\u05e8\u05ea\" \/><\/span><\/span><\/span><br \/>\n\u05db\u05d9\u05e6\u05d3 \u05d0\u05ea\/\u05d4 \u05de\u05d1\u05dc\u05d4 \u05d0\u05ea \u05e9\u05e2\u05d5\u05ea \u05d4\u05e4\u05e0\u05d0\u05d9 \u05e9\u05dc\u05da ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"shaotpnai\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"shaotpnai\"><\/textarea><\/span>\n<\/p>\n<p><strong>\u05de\u05d7\u05d6\u05d5\u05e8 \u05d7\u05d5\u05d3\u05e9\u05d9:<\/strong><br \/>\n\u05d2\u05d9\u05dc \u05d4\u05ea\u05d7\u05dc\u05d4 <span class=\"wpcf7-form-control-wrap\" data-name=\"mahzorgil\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"mahzorgil\" \/><\/span> \u05d1\u05de\u05d9\u05d3\u05d4 \u05d5\u05d4\u05e4\u05e1\u05d9\u05e7, \u05de\u05ea\u05d9 ? <span class=\"wpcf7-form-control-wrap\" data-name=\"gilhafsaka\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"gilhafsaka\" \/><\/span><br \/>\n\u05d6\u05de\u05df \u05d1\u05d9\u05df \u05de\u05d7\u05d6\u05d5\u05e8\u05d9\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"zmandimum\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"zmandimum\" \/><\/span> \u05d6\u05de\u05df \u05d3\u05d9\u05de\u05d5\u05dd <span class=\"wpcf7-form-control-wrap\" data-name=\"zmanveinmahzir\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"zmanveinmahzir\" \/><\/span><br \/>\n\u05ea\u05d5\u05e4\u05e2\u05d5\u05ea \u05dc\u05e4\u05e0\u05d9 \/ \u05d1\u05d6\u05de\u05df \u05d4\u05de\u05d7\u05d6\u05d5\u05e8 (\u05db\u05d0\u05d1\u05d9 \u05d1\u05d8\u05df, \u05e0\u05e4\u05d9\u05d7\u05d5\u05ea \u05d5\u05e8\u05d2\u05d9\u05e9\u05d5\u05ea \u05d1\u05e9\u05d3\u05d9\u05d9\u05dd, \u05e9\u05d9\u05e0\u05d5\u05d9 \u05d1\u05de\u05e6\u05d1 \u05d4\u05e8\u05d5\u05d7 \u05d5\u05db\u05d5') <span class=\"wpcf7-form-control-wrap\" data-name=\"mahzorarea\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"mahzorarea\"><\/textarea><\/span>\n<\/p>\n<p>\u05de\u05d4\u05df \u05d4\u05de\u05d8\u05e8\u05d5\u05ea \u05d0\u05d5\u05ea\u05df \u05d0\u05ea\/\u05d4 \u05de\u05e2\u05d5\u05e0\u05d9\u05d9\u05df\/\u05ea \u05dc\u05d4\u05e9\u05d9\u05d2 \u05d1\u05ea\u05d5\u05dd \u05ea\u05e7\u05d5\u05e4\u05d4 \u05e9\u05dc 3-6 \u05d7\u05d5\u05d3\u05e9\u05d9\u05dd \u05de\u05e2\u05db\u05e9\u05d9\u05d5 ?<br \/>\n1. <span class=\"wpcf7-form-control-wrap\" data-name=\"matara1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"matara1\" \/><\/span><br \/>\n2. <span class=\"wpcf7-form-control-wrap\" data-name=\"matara2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"matara2\" \/><\/span><br \/>\n3. <span class=\"wpcf7-form-control-wrap\" data-name=\"matara3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"matara3\" \/><\/span>\n<\/p>\n<p>\u05d4\u05d0\u05dd \u05e7\u05d9\u05d9\u05de\u05ea \u05e0\u05db\u05d5\u05e0\u05d5\u05ea \u05de\u05e6\u05d9\u05d3\u05da \u05dc\u05d4\u05db\u05e0\u05d9\u05e1 \u05e9\u05d9\u05e0\u05d5\u05d9\u05d9\u05dd \u05d1\u05d4\u05e8\u05d2\u05dc\u05d9 \u05d4\u05d7\u05d9\u05d9\u05dd \u05d5\u05d4\u05ea\u05d6\u05d5\u05e0\u05d4 \u05e9\u05dc\u05da \u05d1\u05de\u05d9\u05d3\u05d4 \u05d5\u05d9\u05d9\u05d3\u05e8\u05e9\u05d5 ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"edkunshinui\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"edkunshinui\"><\/textarea><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u05e9\u05dc\u05d7\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"222\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":548,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-474","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u05e9\u05d0\u05dc\u05d5\u05df \u05d1\u05e8\u05d9\u05d0\u05d5\u05ea - \u05d9\u05e2\u05dc \u05e8\u05d5\u05d8\u05e9\u05d8\u05d9\u05d9\u05df<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/yaelrotstein.co.il\/?page_id=474\" \/>\n<meta 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