{"id":1587,"date":"2020-09-29T14:40:19","date_gmt":"2020-09-29T12:40:19","guid":{"rendered":"https:\/\/docteurchristinecoquart.com\/?page_id=1587"},"modified":"2022-03-09T18:56:35","modified_gmt":"2022-03-09T17:56:35","slug":"demande-de-seance","status":"publish","type":"page","link":"https:\/\/docteurchristinecoquart.com\/demande-de-seance\/","title":{"rendered":"QUESTIONNAIRE INITIAL (ferm\u00e9)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1587\" class=\"elementor elementor-1587\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d0255c4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d0255c4\" 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\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a2bb2dc\" data-id=\"a2bb2dc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ff726ae elementor-widget elementor-widget-spacer\" data-id=\"ff726ae\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a41c0b elementor-widget elementor-widget-shortcode\" data-id=\"2a41c0b\" 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<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1781 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1781\" data-uid=\"6633b5aadf961\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1781\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1781 forminator-design--material  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1781\"\n\t\t\t\t\n\t\t\t\tdata-design=\"material\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6633b5aadf961\"\n\t\t\t><div class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_6633b5aadf961\" class=\"forminator-label\">Nom<\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Par exemple\u00a0: \u00ab\u00a0Jean\u00a0\u00bb\" id=\"forminator-field-first-name-1_6633b5aadf961\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_6633b5aadf961\" class=\"forminator-label\">Pr\u00e9nom<\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Par exemple\u00a0: \u00ab\u00a0Dupont\u00a0\u00bb\" id=\"forminator-field-last-name-1_6633b5aadf961\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6633b5aadf961\" class=\"forminator-label\">Code Postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6633b5aadf961\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1781__field--select-1_6633b5aadf961-label\" class=\"forminator-label\">Pays<\/label><select id=\"forminator-form-1781__field--select-1_6633b5aadf961\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-describedby=\"forminator-form-1781__field--select-1_6633b5aadf961-description\"><option value=\"france\"  data-calculation=\"0\">France<\/option><option value=\"suisse\"  data-calculation=\"0\">Suisse<\/option><option value=\"autre\"  data-calculation=\"0\">Autre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6633b5aadf961\" class=\"forminator-label\">\u00c2ge<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6633b5aadf961\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"radio-1\" class=\"forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6633b5aadf961-label\"><span id=\"forminator-radiogroup-6633b5aadf961-label\" class=\"forminator-label\">Sexe<\/span><label for=\"forminator-field-radio-1-1-6633b5aadf961\" class=\"forminator-radio\" title=\"Femme\"><input type=\"radio\" name=\"radio-1\" value=\"femme\" id=\"forminator-field-radio-1-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-1-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Femme<\/span><\/label><label for=\"forminator-field-radio-1-2-6633b5aadf961\" class=\"forminator-radio\" title=\"Homme\"><input type=\"radio\" name=\"radio-1\" value=\"homme\" id=\"forminator-field-radio-1-2-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-1-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Homme<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6633b5aadf961\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6633b5aadf961\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6633b5aadf961\" class=\"forminator-label\">T\u00e9l\u00e9phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: + 1 300 400 5000\" id=\"forminator-field-phone-1_6633b5aadf961\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6633b5aadf961-label\"><h4 id=\"forminator-checkbox-group-6633b5aadf961-label\" class=\"forminator-label\">Motif de la demande de rendez-vous<\/h4><label for=\"forminator-field-checkbox-1-1-6633b5aadf961\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Fertilit\u00e9\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"fertilit\" id=\"forminator-field-checkbox-1-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-6633b5aadf961-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Fertilit\u00e9<\/span><\/label><label for=\"forminator-field-checkbox-1-2-6633b5aadf961\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Grossesse\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"grossesse\" id=\"forminator-field-checkbox-1-2-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-6633b5aadf961-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Grossesse<\/span><\/label><label for=\"forminator-field-checkbox-1-3-6633b5aadf961\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u00catre maman\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"\u00catre maman\" id=\"forminator-field-checkbox-1-3-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-6633b5aadf961-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u00catre maman<\/span><\/label><label for=\"forminator-field-checkbox-1-4-6633b5aadf961\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Burn-out ~ trauma complexe\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"burnout-trauma-complexe\" id=\"forminator-field-checkbox-1-4-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-6633b5aadf961-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Burn-out ~ trauma complexe<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Histoire personnelle<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6633b5aadf961\" class=\"forminator-label\">Nombre d&#039;enfants<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6633b5aadf961\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" max=\"20\" \/><\/div><\/div><div id=\"radio-2\" class=\"forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6633b5aadf961-label\"><span id=\"forminator-radiogroup-6633b5aadf961-label\" class=\"forminator-label\">Haut-potentiel<\/span><label for=\"forminator-field-radio-2-1-6633b5aadf961\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-2\" value=\"oui\" id=\"forminator-field-radio-2-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-2-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label for=\"forminator-field-radio-2-2-6633b5aadf961\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-2\" value=\"non\" id=\"forminator-field-radio-2-2-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-2-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><label for=\"forminator-field-radio-2-3-6633b5aadf961\" class=\"forminator-radio\" title=\"Ne sais pas\"><input type=\"radio\" name=\"radio-2\" value=\"ne-sais-pas\" id=\"forminator-field-radio-2-3-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-2-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ne sais pas<\/span><\/label><\/div><\/div><div id=\"number-3\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6633b5aadf961\" class=\"forminator-label\">\u00c2ges<\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_6633b5aadf961\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6633b5aadf961-label\"><span id=\"forminator-radiogroup-6633b5aadf961-label\" class=\"forminator-label\">\u00c9v\u00e8nement marquant intra-ut\u00e9rin ou ANOXIE \u00c0 LA NAISSANCE ?<\/span><label for=\"forminator-field-radio-4-1-6633b5aadf961\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-4\" value=\"oui\" id=\"forminator-field-radio-4-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-4-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label for=\"forminator-field-radio-4-2-6633b5aadf961\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-4\" value=\"non\" id=\"forminator-field-radio-4-2-6633b5aadf961\" data-calculation=\"0\" checked=\"checked\" aria-describedby=\"forminator-field-radio-4-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><div id=\"text-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6633b5aadf961\" class=\"forminator-label\">Dans quelles circonstances ?<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-text-2_6633b5aadf961\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6633b5aadf961-label\"><span id=\"forminator-radiogroup-6633b5aadf961-label\" class=\"forminator-label\">D\u00e9m\u00e9nagement ?<\/span><label for=\"forminator-field-radio-5-1-6633b5aadf961\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-5\" value=\"oui\" id=\"forminator-field-radio-5-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-5-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label for=\"forminator-field-radio-5-2-6633b5aadf961\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-5\" value=\"non\" id=\"forminator-field-radio-5-2-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-5-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><div id=\"number-4\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6633b5aadf961\" class=\"forminator-label\">Combien de fois ?<\/label><input name=\"number-4\" value=\"\" placeholder=\"Par exemple\u00a0: 10\" id=\"forminator-field-number-4_6633b5aadf961\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"2\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"radio-6\" class=\"forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6633b5aadf961-label\"><span id=\"forminator-radiogroup-6633b5aadf961-label\" class=\"forminator-label\">D\u2019un pays (culture) \u00e0 un(e) autre ?<\/span><label for=\"forminator-field-radio-6-1-6633b5aadf961\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-6\" value=\"oui\" id=\"forminator-field-radio-6-1-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-6-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label for=\"forminator-field-radio-6-2-6633b5aadf961\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-6\" value=\"non\" id=\"forminator-field-radio-6-2-6633b5aadf961\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-6-6633b5aadf961-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Questions sur \u00ab ici et maintenant \u00bb et intention de consultation :<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6633b5aadf961\" class=\"forminator-label\">\u00c9tat physique : 2\u00e03 PRINCIPAUX SYMPT\u00d4MES (douleurs \u00c0 -C, acidit\u00e9 G, surpoids, maladie\u2026) ?<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6633b5aadf961\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6633b5aadf961\" class=\"forminator-label\">\u00c9tat psychique : 2\u00e03 PRINCIPAUX SYMPT\u00d4MES (stress A-C plus ou moins extr\u00eame, burn out, anxi\u00e9t\u00e9 \u00e0 quel degr\u00e9 insomnie etc...) ?<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6633b5aadf961\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6633b5aadf961\" class=\"forminator-label\">\u00c9tat de vie : RELATIONS et liens actuellement -&gt; la Situation \u00e0 d\u00e9bloquer l\u00e0 +++ actuellement qui a initi\u00e9 la demande de cs ?<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6633b5aadf961\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6633b5aadf961\" class=\"forminator-label\">Avec quoi suis-je en d\u00e9saccord et\/ou en contradiction avec moi-m\u00eame ?<\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_6633b5aadf961\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6633b5aadf961\" class=\"forminator-label\">Ai-je d\u00e9j\u00e0 v\u00e9cu un pass\u00e9 semblable ? en quoi cet \u00e9v\u00e9nement m\u2019a touch\u00e9 ds l\u2019image que j\u2019ai de moi<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6633b5aadf961\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" maxlength=\"100\" ><\/textarea><span id=\"forminator-field-textarea-1_6633b5aadf961-description\" class=\"forminator-description\"><span data-limit=\"100\" data-type=\"characters\">0 \/ 100<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_6633b5aadf961\" class=\"forminator-label\">Commentaire libre<\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_6633b5aadf961\" 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