{"id":528,"date":"2019-10-17T13:09:24","date_gmt":"2019-10-17T17:09:24","guid":{"rendered":"https:\/\/www.cpoutaouais.com\/?page_id=528"},"modified":"2025-01-21T14:20:50","modified_gmt":"2025-01-21T19:20:50","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/www.cpoutaouais.com\/en\/book-an-appointment\/","title":{"rendered":"Book an appointment"},"content":{"rendered":"<div class=\"lc-block fr form-container\">\n<div lc-helper=\"shortcode\" class=\"live-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f532-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"532\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/528#wpcf7-f532-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=\"532\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f532-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"theForm\">\n  <div class=\"form-row\">\n    <div class=\"col-12\">\n      <h3 class=\"mt-0\">Inscription informations<\/h3>\n    <\/div>\n    <div class=\"col-12 col-sm-6\">\n      <div class=\"form-group\">\n        <label for=\"firstname\">First name&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"firstname\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span>\n      <\/div>\n    <\/div>\n    <div class=\"col-12 col-sm-6\">\n      <div class=\"form-group\">\n        <label for=\"lastname\">Last name&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"lastname\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lastname\" \/><\/span>\n      <\/div>\n    <\/div>\n    <div class=\"col-12 col-sm-6\">\n      <div class=\"form-group\">\n        <label for=\"email\">Email&nbsp;*<\/label><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\" id=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n      <\/div>\n    <\/div>\n    <div class=\"col-12 col-sm-6\">\n      <div class=\"form-group\">\n        <label for=\"phone\">Phone&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" id=\"phone\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n      <\/div>\n    <\/div>\n  <\/div>\n  <div class=\"form-row\">\n    <div class=\"col-12\">\n      <h3>Demand informations<\/h3>\n    <\/div>\n    <div class=\"col-12\">\n      <div class=\"form-group d-none\">\n        <label for=\"ville\">Choose your clinic&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"ville\" aria-invalid=\"false\" name=\"ville\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Gatineau\">Gatineau<\/option><option value=\"Hull\">Hull<\/option><\/select><\/span>\n      <\/div>\n      <div class=\"form-group\">\n        <label for=\"reason\">Reason for the consultation request&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"reason\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"reason\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason\" \/><\/span>\n      <\/div>\n    <\/div>    \n  <\/div>\n  <div class=\"form-row\">\n    <div class=\"col-12\">\n      <h3>Other informations<\/h3>\n      <label for=\"comments\">Comments&nbsp;*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"comments\"><textarea cols=\"40\" rows=\"5\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" id=\"comments\" aria-required=\"true\" aria-invalid=\"false\" name=\"comments\"><\/textarea><\/span>\n    <\/div>\n  <\/div>\n<div class=\"form-row\">\n<div class=\"col-12\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"confEmail\"><input size=\"40\" 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class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n<p><!-- \/lc-block 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