{"id":3104,"date":"2017-03-24T19:46:25","date_gmt":"2017-03-24T23:46:25","guid":{"rendered":"http:\/\/amsclinic.ca\/demande-de-consultation\/"},"modified":"2024-06-19T17:12:55","modified_gmt":"2024-06-19T21:12:55","slug":"rendez-vous","status":"publish","type":"page","link":"https:\/\/amsclinic.ca\/fr\/rendez-vous\/","title":{"rendered":"Rendez-vous"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; fullwidth=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb4.16&Prime; transparent_background=\u00a0\u00bboff\u00a0\u00bb make_fullwidth=\u00a0\u00bboff\u00a0\u00bb use_custom_width=\u00a0\u00bboff\u00a0\u00bb width_unit=\u00a0\u00bbon\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_fullwidth_slider module_class=\u00a0\u00bbinternal-slider titled\u00a0\u00bb _builder_version=\u00a0\u00bb4.22.1&Prime; custom_padding=\u00a0\u00bb|||\u00a0\u00bb custom_padding_tablet=\u00a0\u00bb|||\u00a0\u00bb custom_padding_phone=\u00a0\u00bb|||\u00a0\u00bb box_shadow_style=\u00a0\u00bbpreset6&Prime; 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background_size=\u00a0\u00bbinitial\u00a0\u00bb background_position=\u00a0\u00bbtop_left\u00a0\u00bb background_repeat=\u00a0\u00bbrepeat\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.16&Prime; custom_padding=\u00a0\u00bb|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb custom_padding__hover=\u00a0\u00bb|||\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.16&Prime; text_font=\u00a0\u00bb|on|||\u00a0\u00bb text_font_size=\u00a0\u00bb15&Prime; background_size=\u00a0\u00bbinitial\u00a0\u00bb background_position=\u00a0\u00bbtop_left\u00a0\u00bb background_repeat=\u00a0\u00bbrepeat\u00a0\u00bb text_orientation=\u00a0\u00bbcenter\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb use_border_color=\u00a0\u00bboff\u00a0\u00bb border_color=\u00a0\u00bb#ffffff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p>\n&#8212; OU REMPLISSEZ LE FORMULAIRE CI-DESSOUS &#8212;<\/p>\n<p>[\/et_pb_text][et_pb_code admin_label=\u00a0\u00bbAppointment Form\u00a0\u00bb _builder_version=\u00a0\u00bb4.16&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3410-o1\" lang=\"en-CA\" dir=\"ltr\" data-wpcf7-id=\"3410\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/3104#wpcf7-f3410-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3410\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_CA\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3410-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div id=\"cf7_form\" class=\"cf7_responsive_form\">\n\t<div class=\"full\">\n\t\t<h3>Type de rendez-vous\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"APP_TYPE\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required oopl\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Rendez-vous r\u00e9gulier en Physioth\u00e9rapie\" \/><span class=\"wpcf7-list-item-label\">Rendez-vous r\u00e9gulier en Physioth\u00e9rapie<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Rendez-vous en massoth\u00e9rapie\" \/><span class=\"wpcf7-list-item-label\">Rendez-vous en massoth\u00e9rapie<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Demande de consultation gratuite (disponible \u00e0 Dorval et C\u00f4te-des-Neiges)\" \/><span class=\"wpcf7-list-item-label\">Demande de consultation gratuite (disponible \u00e0 Dorval et C\u00f4te-des-Neiges)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Rendez-vous sans frais en post r\u00e9adaptation - si vous \u00eates un ancien patient ou patient actif. Cette consultation est gratuite et offerte dans le plan de soins de chaque patient. (disponible \u00e0 Dorval ou C\u00f4te-des-Neiges)\" \/><span class=\"wpcf7-list-item-label\">Rendez-vous sans frais en post r\u00e9adaptation - si vous \u00eates un ancien patient ou patient actif. Cette consultation est gratuite et offerte dans le plan de soins de chaque patient. (disponible \u00e0 Dorval ou C\u00f4te-des-Neiges)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Autre rendez-vous\" \/><span class=\"wpcf7-list-item-label\">Autre rendez-vous<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"APP_TYPE[]\" value=\"Rendez-vous sans frais en orthop\u00e9die avec un physioth\u00e9rapeute pour d\u00e9terminer quel genre d&#039;orth\u00e8se orthop\u00e9dique vous avez besoin (disponible \u00e0 Dorval et C\u00f4te-des-Neiges)\" \/><span class=\"wpcf7-list-item-label\">Rendez-vous sans frais en orthop\u00e9die avec un physioth\u00e9rapeute pour d\u00e9terminer quel genre d&#039;orth\u00e8se orthop\u00e9dique vous avez besoin (disponible \u00e0 Dorval et C\u00f4te-des-Neiges)<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"left\">\n\t\t<h3>Pr\u00e9nom\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"FNAME\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"FNAME\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"right\">\n\t\t<h3>Nom de famille\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"LNAME\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"LNAME\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"left\">\n\t\t<h3>Date de naissance\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DOB\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"DOB\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"left\">\n\t\t<h3>Adresse courriel\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"EMAIL\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"EMAIL\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"right\">\n\t\t<h3>T\u00e9l\u00e9phone\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PHONE\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PHONE\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"left\">\n\t\t<h3>La partie du corps en question\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"BODY_PART\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"BODY_PART\"><option value=\"\">-- Selectionez une --<\/option><option value=\"Dos\">Dos<\/option><option value=\"Cou\">Cou<\/option><option value=\"\u00c9paule\">\u00c9paule<\/option><option value=\"Coude\">Coude<\/option><option value=\"Poignet\">Poignet<\/option><option value=\"Hanche\">Hanche<\/option><option value=\"Genou\">Genou<\/option><option value=\"Cheville\">Cheville<\/option><option value=\"Autre\">Autre<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p>[group type_other]\n\t<\/p>\n\t<div class=\"right\">\n\t\t<h3>SVP indiquez\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"BODY_PART_OTHER\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"BODY_PART_OTHER\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p>[\/group]\n\t<\/p>\n\t<div class=\"left\">\n\t\t<h3>Jour et heure de rendez-vous favoris\u00e9s\n\t\t<\/h3>\n\t\t<p>[datetime DATETIME date-format:mm\/dd\/yy time-format:HH:mm no-weekends]\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"right\">\n\t\t<h3>Endroit\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"LOCATION\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"LOCATION\"><option value=\"\">-- Choisissez la clinique --<\/option><option value=\"Dorval\">Dorval<\/option><option value=\"Lachine\">Lachine<\/option><option value=\"C\u00f4te-des-Neiges Montr\u00e9al\">C\u00f4te-des-Neiges Montr\u00e9al<\/option><option value=\"Centre-ville de Montr\u00e9al (Sherbrooke\/D\u00e9carie)\">Centre-ville de Montr\u00e9al (Sherbrooke\/D\u00e9carie)<\/option><option value=\"Montr\u00e9al-Nord (Fleury\/Papineau)\">Montr\u00e9al-Nord (Fleury\/Papineau)<\/option><option value=\"Montr\u00e9al-Est (Beaubien\/Langelier)\">Montr\u00e9al-Est (Beaubien\/Langelier)<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"full\">\n\t\t<h3>Message\n\t\t<\/h3>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"MESSAGE\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"MESSAGE\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"full\">\n\t\t<p>En conformit\u00e9 avec les lois anti-pourriel du Canada, vous comprenez qu'en cliquant sur Envoyer, vous nous donnez la permission de vous envoyer des informations sur les produits et services et des informations telles que des nouvelles et des \u00e9v\u00e9nements.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACKNOWLEDGEMENT\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"ACKNOWLEDGEMENT[]\" value=\"Je suis d&#039;accord\" \/><span class=\"wpcf7-list-item-label\">Je suis 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