{"id":74,"date":"2014-09-02T20:29:03","date_gmt":"2014-09-02T20:29:03","guid":{"rendered":"https:\/\/www.embrunortho.com\/?page_id=74"},"modified":"2014-09-24T19:34:42","modified_gmt":"2014-09-24T19:34:42","slug":"prendre-rendez-vous","status":"publish","type":"page","link":"https:\/\/www.embrunortho.com\/fr\/prendre-rendez-vous\/","title":{"rendered":"Prendre un rendez-vous"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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Nous vous contacterons sous peu afin de confirmer la date et l'heure du rendez-vous.<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/fr\/wp-json\/wp\/v2\/pages\/74' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h3 class=\"gsection_title\">Information du patient<\/h3><\/div><fieldset id=\"field_1_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Nom du patient<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            <span id='input_1_1_3_container' class='name_first gform-grid-col'>\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                               <\/span>\n                            <span id='input_1_1_6_container' class='name_last gform-grid-col'>\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_3'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_3' id='input_1_3' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_1_3_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_3_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_3' class='gform_hidden' value='https:\/\/www.embrunortho.com\/extras\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_1_2\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Nom du parent (si applicable)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_2'>\n                            <span id='input_1_2_3_container' class='name_first gform-grid-col'>\n                                                    <input type='text' name='input_2.3' id='input_1_2_3' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_2_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                               <\/span>\n                            <span id='input_1_2_6_container' class='name_last gform-grid-col'>\n                                                    <input type='text' name='input_2.6' id='input_1_2_6' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_2_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/fieldset><fieldset id=\"field_1_15\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Nom du parent additionnel (si applicable)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_15'>\n                            <span id='input_1_15_3_container' class='name_first gform-grid-col'>\n                                                    <input type='text' name='input_15.3' id='input_1_15_3' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_15_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                               <\/span>\n                            <span id='input_1_15_6_container' class='name_last gform-grid-col'>\n                                                    <input type='text' name='input_15.6' id='input_1_15_6' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_15_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/fieldset><fieldset id=\"field_1_4\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_1_4'>\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_4_1_container'>\n                                        <input type='text' name='input_4.1' id='input_1_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_4_1' id='input_1_4_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_4_2_container'>\n                                        <input type='text' name='input_4.2' id='input_1_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_4_2' id='input_1_4_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_4_3_container'>\n                                    <input type='text' name='input_4.3' id='input_1_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_4_3' id='input_1_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_4_4_container'>\n                                        <select name='input_4.4' id='input_1_4_4'     aria-required='true'><option value=''><\/option><option value='Alberta'>Alberta<\/option><option value='Colombie-Britannique'>Colombie-Britannique<\/option><option value='Manitoba'>Manitoba<\/option><option value='Nouveau-Brunswick'>Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador'>Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest'>Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse'>Nouvelle-\u00c9cosse<\/option><option value='Nunavut'>Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard'>\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec'>Qu\u00e9bec<\/option><option value='Saskatchewan'>Saskatchewan<\/option><option value='Yukon'>Yukon<\/option><\/select>\n                                        <label for='input_1_4_4' id='input_1_4_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_4_5_container'>\n                                    <input type='text' name='input_4.5' id='input_1_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_4_5' id='input_1_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_1_4_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_5\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_5'>Num\u00e9ro de t\u00e9l\u00e9phone (jour)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_1_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_6'>Num\u00e9ro de t\u00e9l\u00e9phone (alternatif)<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_1_6' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_7\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_7'>Courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_1_7' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h3 class=\"gsection_title\">D\u00e9tails du rendez-vous<\/h3><\/div><div id=\"field_1_16\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_16'>Fournisseur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_1_16' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\"><option value='Dr. Carolyne Thain, Orthodontiste'>Dr. Carolyne Thain, Orthodontiste<\/option><option value='Dr. Noh\u00e9 Sassi'>Dr. Noh\u00e9 Sassi<\/option><option value='Tom Szarski, Denturist'>Tom Szarski, Denturist<\/option><\/select><\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class='gfield_label gform-field-label' for='input_1_10'>Inqui\u00e9tudes<\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_1_10' class='medium gfield_select'     aria-invalid=\"false\"><option value='\u00c9valuation orthodontique compl\u00e8te'>\u00c9valuation orthodontique compl\u00e8te<\/option><option value='Rec\u00e9duler un rendez-vous existant (minimum de 48 heures \u00e0 l\u2019avance)'>Rec\u00e9duler un rendez-vous existant (minimum de 48 heures \u00e0 l\u2019avance)<\/option><\/select><\/div><\/div><fieldset id=\"field_1_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Quelle journ\u00e9e pr\u00e9f\u00e9rez-vous? 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