>
        <input type="hidden" name="referrer" value="{{ settings.referrer }}">
        <input type="hidden" name="language" value="{{ page.language }}">

        {% if value.was_it_helpful_text %}
        <div class="o-form_group">
            <h3>
                {{ _(value.was_it_helpful_text) }}
            </h3>
            <fieldset class="o-form_fieldset">
                <ul class="content-l m-list m-list__unstyled">
                    <li class="content-l_col content-l_col-1-2">
                  