{"id":16527,"date":"2022-03-19T14:45:58","date_gmt":"2022-03-19T13:45:58","guid":{"rendered":"https:\/\/docteurchristinecoquart.com\/?page_id=16527"},"modified":"2023-07-26T10:33:37","modified_gmt":"2023-07-26T08:33:37","slug":"demande-de-premiere-consultation","status":"publish","type":"page","link":"https:\/\/docteurchristinecoquart.com\/demande-de-premiere-consultation\/","title":{"rendered":"Demande de Premi\u00e8re Consultation"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"16527\" class=\"elementor elementor-16527\">\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-1aed900 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1aed900\" 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-f01db09\" data-id=\"f01db09\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-f0c0660 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f0c0660\" 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-5392010\" data-id=\"5392010\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-4eb45f0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4eb45f0\" 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-6ed539d\" data-id=\"6ed539d\" 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-acd9f40 elementor-widget elementor-widget-spacer\" data-id=\"acd9f40\" 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\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-c3243a7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c3243a7\" 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-33 elementor-top-column elementor-element elementor-element-1a63734\" data-id=\"1a63734\" 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-5f044d4 elementor-widget elementor-widget-heading\" data-id=\"5f044d4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Demande<br>de<br>S\u00e9ance<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-5a29e5d\" data-id=\"5a29e5d\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-7bfbc29 elementor-widget elementor-widget-image\" data-id=\"7bfbc29\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"260\" height=\"320\" src=\"https:\/\/docteurchristinecoquart.com\/wp-content\/uploads\/2022\/03\/E1B425AC-9A90-46EF-8842-2D21D8169EF0.jpeg\" class=\"attachment-full size-full wp-image-16541\" alt=\"\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-ef38217 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ef38217\" 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-7bc22f8\" data-id=\"7bc22f8\" 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-cbd5903 elementor-widget elementor-widget-spacer\" data-id=\"cbd5903\" 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\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-669eee9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"669eee9\" 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-735e03d\" data-id=\"735e03d\" 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-35a043f elementor-widget elementor-widget-text-editor\" data-id=\"35a043f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<h2 style=\"font-family: Sriracha, sans-serif; letter-spacing: 1.2px; font-size: 42px; color: var( --e-global-color-5196ff9 ); text-align: center;\" data-elementor-setting-key=\"title\" data-pen-placeholder=\"\u00c9crivez ici...\">Pour la prise de rdv, merci de r\u00e9pondre et soumettre le questionnaire<span style=\"color: var( --e-global-color-5196ff9 ); letter-spacing: 1.2px; -webkit-tap-highlight-color: transparent; -webkit-text-size-adjust: 100%;\">*<\/span><span style=\"color: var( --e-global-color-5196ff9 ); letter-spacing: 1.2px; -webkit-tap-highlight-color: transparent; -webkit-text-size-adjust: 100%;\">\u00a0ci-dessous<\/span><\/h2>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68eece6 elementor-widget elementor-widget-text-editor\" data-id=\"68eece6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>* Toutes ces informations sont bien s\u00fbr confidentielles et soumises au secret m\u00e9dical<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-cc1ec0b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cc1ec0b\" 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-0dbb1e5\" data-id=\"0dbb1e5\" 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-1141880 elementor-widget elementor-widget-shortcode\" data-id=\"1141880\" 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-15770 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-15770\" data-uid=\"663741ac4e631\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-15770\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-15770 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=\"15770\"\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=\"663741ac4e631\"\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-field\"><label for=\"forminator-field-name-1_663741ac4e631\" class=\"forminator-label\">Nom Pr\u00e9nom<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: \u00ab\u00a0Jacques Martin\u00a0\u00bb\" id=\"forminator-field-name-1_663741ac4e631\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_663741ac4e631\" class=\"forminator-label\">Code Postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_663741ac4e631\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-15770__field--select-1_663741ac4e631-label\" class=\"forminator-label\">Pays<\/label><select id=\"forminator-form-15770__field--select-1_663741ac4e631\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" aria-describedby=\"forminator-form-15770__field--select-1_663741ac4e631-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 id=\"phone-1\" class=\"forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_663741ac4e631\" 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_663741ac4e631\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/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_663741ac4e631\" class=\"forminator-label\">\u00c2ge<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_663741ac4e631\" 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-663741ac4e631-label\"><span id=\"forminator-radiogroup-663741ac4e631-label\" class=\"forminator-label\">Sexe<\/span><label for=\"forminator-field-radio-1-1-663741ac4e631\" class=\"forminator-radio\" title=\"Femme\"><input type=\"radio\" name=\"radio-1\" value=\"femme\" id=\"forminator-field-radio-1-1-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-1-663741ac4e631-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Femme<\/span><\/label><label for=\"forminator-field-radio-1-2-663741ac4e631\" class=\"forminator-radio\" title=\"Homme\"><input type=\"radio\" name=\"radio-1\" value=\"homme\" id=\"forminator-field-radio-1-2-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-1-663741ac4e631-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-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_663741ac4e631\" 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_663741ac4e631\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_663741ac4e631\" class=\"forminator-label\">Nombre d&#039;enfants<\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_663741ac4e631\" 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=\"checkbox-2\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-663741ac4e631-label\"><h4 id=\"forminator-checkbox-group-663741ac4e631-label\" class=\"forminator-label\">\u00c2ge(s)<\/h4><label for=\"forminator-field-checkbox-2-1-663741ac4e631\" class=\"forminator-checkbox\" title=\"B\u00e9b\u00e9\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"B\u00e9b\u00e9\" id=\"forminator-field-checkbox-2-1-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-2-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">B\u00e9b\u00e9<\/span><\/label><label for=\"forminator-field-checkbox-2-2-663741ac4e631\" class=\"forminator-checkbox\" title=\"Enfant\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Enfant\" id=\"forminator-field-checkbox-2-2-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-2-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Enfant<\/span><\/label><label for=\"forminator-field-checkbox-2-3-663741ac4e631\" class=\"forminator-checkbox\" title=\"Ado\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Ado\" id=\"forminator-field-checkbox-2-3-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-2-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ado<\/span><\/label><\/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-663741ac4e631-label\"><h4 id=\"forminator-checkbox-group-663741ac4e631-label\" class=\"forminator-label\">Motif de la demande de rendez-vous<\/h4><label for=\"forminator-field-checkbox-1-1-663741ac4e631\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Fertilit\u00e9\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"fertilit\" id=\"forminator-field-checkbox-1-1-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Fertilit\u00e9<\/span><\/label><label for=\"forminator-field-checkbox-1-2-663741ac4e631\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Grossesse - Soins B\u00e9b\u00e9s\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Grossesse---Soins-B\u00e9b\u00e9s\" id=\"forminator-field-checkbox-1-2-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Grossesse - Soins B\u00e9b\u00e9s<\/span><\/label><label for=\"forminator-field-checkbox-1-3-663741ac4e631\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Burn-out\/trauma\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Burn-out-trauma\" id=\"forminator-field-checkbox-1-3-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-checkbox-1-663741ac4e631-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Burn-out\/trauma<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p><strong>D\u00e9crivez votre besoin et votre intention vis \u00e0 vis de la consultation*<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_663741ac4e631\" class=\"forminator-label\">Commentaire libre<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_663741ac4e631\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" maxlength=\"300\" ><\/textarea><span id=\"forminator-field-textarea-3_663741ac4e631-description\" class=\"forminator-description\"><span data-limit=\"300\" data-type=\"characters\">0 \/ 300<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-663741ac4e631-label\"><span id=\"forminator-radiogroup-663741ac4e631-label\" class=\"forminator-label\">Votre demande a-t-elle un caract\u00e8re d&#039;urgence ?<\/span><label for=\"forminator-field-radio-3-1-663741ac4e631\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-3\" value=\"oui\" id=\"forminator-field-radio-3-1-663741ac4e631\" data-calculation=\"0\"  aria-describedby=\"forminator-field-radio-3-663741ac4e631-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label for=\"forminator-field-radio-3-2-663741ac4e631\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-3\" value=\"non\" id=\"forminator-field-radio-3-2-663741ac4e631\" data-calculation=\"0\" checked=\"checked\" aria-describedby=\"forminator-field-radio-3-663741ac4e631-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><div id=\"textarea-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_663741ac4e631\" class=\"forminator-label\">Quelle urgence ?<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_663741ac4e631\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" maxlength=\"100\" ><\/textarea><span id=\"forminator-field-textarea-2_663741ac4e631-description\" class=\"forminator-description\"><span data-limit=\"100\" data-type=\"characters\">0 \/ 100<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6LcVhhsgAAAAAAaPouBWEiwmveXKk6nT90j81LHX\" data-size=\"invisible\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Envoyer le message<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"7afdd29882\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/16527\" \/><input type=\"hidden\" name=\"form_id\" value=\"15770\"><input type=\"hidden\" name=\"page_id\" value=\"16527\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/docteurchristinecoquart.com\/demande-de-premiere-consultation\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\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-961efcc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"961efcc\" 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-a48d1eb\" data-id=\"a48d1eb\" 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-c22e061 elementor-widget elementor-widget-text-editor\" data-id=\"c22e061\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>* Indiquer ici si vous \u00eates hors zone euro =&gt; le paiement se fera alors via PayPal. C\u2019est aussi ici que vous pouvez me faire une proposition de r\u00e8glement argument\u00e9e et raisonnable, si je vous semble trop ch\u00e8re pour vous.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DemandedeS\u00e9ance Pour la prise de rdv, merci de r\u00e9pondre et soumettre le questionnaire*\u00a0ci-dessous * Toutes ces informations sont bien s\u00fbr confidentielles et soumises au secret m\u00e9dical * Indiquer ici si vous \u00eates hors zone euro =&gt; le paiement se fera alors via PayPal. C\u2019est aussi ici que vous pouvez me faire une proposition de r\u00e8glement [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/pages\/16527"}],"collection":[{"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/comments?post=16527"}],"version-history":[{"count":12,"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/pages\/16527\/revisions"}],"predecessor-version":[{"id":20814,"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/pages\/16527\/revisions\/20814"}],"wp:attachment":[{"href":"https:\/\/docteurchristinecoquart.com\/wp-json\/wp\/v2\/media?parent=16527"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}