{"id":7394,"date":"2018-09-17T14:24:35","date_gmt":"2018-09-17T18:24:35","guid":{"rendered":"https:\/\/cliniquemedicalelesentier.com\/appointment\/"},"modified":"2024-05-03T17:22:56","modified_gmt":"2024-05-03T21:22:56","slug":"appointment","status":"publish","type":"page","link":"https:\/\/cliniquemedicalelesentier.com\/en\/appointment\/","title":{"rendered":"I have a family doctor at the clinic"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row full_width=&#8221;0&#8243; full_height=&#8221;0&#8243; particles=&#8221;0&#8243;][vc_column margin=&#8221;margin_bottom_grid&#8221; animation=&#8221;wow fadeInLeft&#8221;][vc_text_separator title=&#8221;How to schedule an appointment&#8221; i_icon_fontawesome=&#8221;fa fa-calendar-check-o&#8221; add_icon=&#8221;true&#8221;][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_btn title=&#8221;Minor emergency appointment&#8221; style=&#8221;3d&#8221; color=&#8221;sky&#8221; align=&#8221;center&#8221; i_icon_fontawesome=&#8221;far fa-calendar-alt&#8221; css_animation=&#8221;appear&#8221; add_icon=&#8221;true&#8221; link=&#8221;url:https%3A%2F%2Fcliniquemedicalelesentier.com%2Fen%2Fappointment%2F%23urgencemineure|title:Minor%20emergency%20appointment|&#8221;][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_btn title=&#8221;Follow-up Appointment&#8221; style=&#8221;3d&#8221; color=&#8221;sky&#8221; align=&#8221;center&#8221; i_icon_fontawesome=&#8221;far fa-calendar-alt&#8221; css_animation=&#8221;appear&#8221; add_icon=&#8221;true&#8221; link=&#8221;url:https%3A%2F%2Fcliniquemedicalelesentier.com%2Fen%2Fappointment%2F%23suivi|title:Minor%20emergency%20appointment|&#8221;][\/vc_column][vc_column][vc_custom_heading text=&#8221;Family doctors of the Clinique m\u00e9dicale Le Sentier<br \/>\nare using the advanced <strong>access model for appointments.<\/strong>&#8221; font_container=&#8221;tag:div|font_size:20|text_align:center&#8221; google_fonts=&#8221;font_family:Merienda%3Aregular%2C700|font_style:400%20regular%3A400%3Anormal&#8221; css=&#8221;.vc_custom_1656705174323{margin-top: 20px !important;margin-bottom: 15px !important;}&#8221;][vc_btn title=&#8221;To Learn More About Advanced Access&#8221; style=&#8221;3d&#8221; color=&#8221;sky&#8221; align=&#8221;center&#8221; i_icon_fontawesome=&#8221;fas fa-exclamation-circle&#8221; css_animation=&#8221;appear&#8221; add_icon=&#8221;true&#8221; link=&#8221;url:https%3A%2F%2Fcliniquemedicalelesentier.com%2Fen%2Fadvanced-access%2F|title:Advanced%20Access|&#8221;][vc_message message_box_color=&#8221;warning&#8221; icon_fontawesome=&#8221;fas fa-exclamation-triangle&#8221; css_animation=&#8221;fadeInUp&#8221; css=&#8221;.vc_custom_1714771372655{margin-top: 56px !important;}&#8221;]<\/p>\n<p style=\"font-weight: 400;\"><strong>Appointment delay and cancellation policy<\/strong><\/p>\n<p style=\"font-weight: 400;\">If you need to cancel an appointment, you must notify us at least 24 hours in advance by calling us at <a href=\"tel:+14506903690\">450 690-3690<\/a> ext. 6. In addition, if you do not show up for your appointment, a fee of $35 will be requested.<\/p>\n<p>After being 10 minutes late for your appointment, we will have to check with the doctor if he can still see you. If not, your appointment will be considered missed. Therefore, a $35 fee will apply.[\/vc_message][\/vc_column][\/vc_row][vc_row full_width=&#8221;0&#8243; full_height=&#8221;0&#8243; row_padding=&#8221;no_padding&#8221; particles=&#8221;0&#8243; css=&#8221;.vc_custom_1656768222011{background-color: #f4f4f4 !important;}&#8221;][vc_column][vc_wp_text]<a id=\"urgencemineure\"><\/a><span style=\"color: #ffffff;\">.<\/span><br \/>\n[\/vc_wp_text][\/vc_column][\/vc_row][vc_row color_set=&#8221;white_section&#8221; full_width=&#8221;0&#8243; full_height=&#8221;0&#8243; cols_valign=&#8221;vcenter&#8221; particles=&#8221;0&#8243; css=&#8221;.vc_custom_1656722473645{margin-bottom: 0px !important;}&#8221;][vc_column][vc_text_separator title=&#8221;Minor emergency appointment&#8221; i_icon_fontawesome=&#8221;fa fa-calendar-check-o&#8221; add_icon=&#8221;true&#8221;][vc_column_text css=&#8221;.vc_custom_1656710292662{margin-top: 20px !important;margin-right: 10px !important;margin-bottom: 5px !important;margin-left: 10px !important;border-top-width: 0px !important;border-right-width: 0px !important;border-bottom-width: 0px !important;border-left-width: 0px !important;padding-top: 15px !important;padding-right: 15px !important;padding-bottom: 15px !important;padding-left: 15px !important;border-left-color: #c6c6c6 !important;border-right-color: #c6c6c6 !important;border-top-color: #c6c6c6 !important;border-bottom-color: #c6c6c6 !important;border-radius: 20px !important;}&#8221;]<\/p>\n<p style=\"font-size: 20px;\"><i>You have\u00a0<strong>a minor emergency<\/strong>\u00a0and you want\u00a0<strong>to see your family doctor<\/strong>\u00a0within 72 hours?<\/i><\/p>\n<p><i>we ask that you make your appointment via the\u00a0<a href=\"https:\/\/rvsq.gouv.qc.ca\/prendrerendezvous\/Default.aspx?culture=en\" target=\"_blank\" rel=\"noopener\">Rendez-vous Sant\u00e9 Qu\u00e9bec (Qu\u00e9bec Medical Appointment Scheduler)\u00a0<\/a>.<\/i><\/p>\n<p>[\/vc_column_text][vc_empty_space][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_single_image image=&#8221;17241&#8243; img_size=&#8221;full&#8221; onclick=&#8221;custom_link&#8221; img_link_target=&#8221;_blank&#8221; link=&#8221;https:%2F%2Frvsq.gouv.qc.ca%2Fprendrerendezvous%2FDefault.aspx%3Fculture%3Dfr|&#8221;][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_video link=&#8221;https:\/\/youtu.be\/Z4CV_tMonLo&#8221; css_animation=&#8221;none&#8221;][\/vc_column][vc_column][vc_column_text css=&#8221;.vc_custom_1666922267199{margin-top: 20px !important;margin-right: 10px !important;margin-bottom: 5px !important;margin-left: 10px !important;border-top-width: 0px !important;border-right-width: 0px !important;border-bottom-width: 0px !important;border-left-width: 0px !important;padding-top: 15px !important;padding-right: 15px !important;padding-bottom: 15px !important;padding-left: 15px !important;border-left-color: #c6c6c6 !important;border-right-color: #c6c6c6 !important;border-top-color: #c6c6c6 !important;border-bottom-color: #c6c6c6 !important;border-radius: 20px !important;}&#8221;]<\/p>\n<p style=\"font-size: 20px;\"><i>Examples of minor emergencies: urinary tract infection, fever for more than 48 hours, flu, acute sore throat, strong and new pain, fracture, etc.<\/i><\/p>\n<p style=\"font-size: 20px;\"><span style=\"color: #993366;\"><i>****It is important to use the minor emergency appointment slots only if the situation is <strong>urgent<\/strong>****<\/i><\/span><\/p>\n<p style=\"font-size: 20px;\"><i> <em>If your family doctor is not available, you will have access to appointment slots with the doctor at the minor emergency clinic, depending on availability.<\/em><\/i><\/p>\n<p style=\"font-size: 20px;\"><i> <em>Bookings for the emergency clinic\u2019s first availabilities start at 8:00 p.m. the night before and at 6:00 a.m. the morning of for the second batch of availabilities.<\/em><\/i><\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=&#8221;0&#8243; full_height=&#8221;0&#8243; row_padding=&#8221;no_padding&#8221; particles=&#8221;0&#8243;][vc_column][vc_wp_text]<a id=\"DemandeRV\"><\/a><span style=\"color: #ffffff;\">.<\/span><br \/>\n<a id=\"suivi\"><\/a><span style=\"color: #ffffff;\">.<\/span>[\/vc_wp_text][\/vc_column][\/vc_row][vc_row color_set=&#8221;white_section&#8221; full_width=&#8221;0&#8243; full_height=&#8221;0&#8243; cols_valign=&#8221;vcenter&#8221; particles=&#8221;0&#8243; css=&#8221;.vc_custom_1656768105288{margin-bottom: 0px !important;background-color: #f4f4f4 !important;}&#8221;][vc_column align=&#8221;text-center&#8221;][vc_text_separator title=&#8221;Follow-up Appointment&#8221; i_icon_fontawesome=&#8221;fa fa-calendar-check-o&#8221; add_icon=&#8221;true&#8221;][\/vc_column][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243; css=&#8221;.vc_custom_1653603358535{background-color: #f4f4f4 !important;}&#8221;][vc_empty_space][vc_message message_box_color=&#8221;warning&#8221; icon_fontawesome=&#8221;fa fa-exclamation-triangle&#8221;]<span style=\"color: #ff0000;\">You must be registered as a patient of a family doctor at La Clinique m\u00e9dicale Le Sentier to use this form. Otherwise, please note that you will not receive any response to your appointment request.<\/span>[\/vc_message]<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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework formulaire_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Demande de rendez-vous<\/h3>\n                            <p class='gform_description'>Remplissez ce formulaire pour demander un rendez-vous.  La secr\u00e9taire vous contactera par courriel ou par t\u00e9l\u00e9phone pour vous confirmer la date et l'heure de votre rendez-vous.<br\/>\r\n* Si vous utilisez ce formulaire, merci de ne pas nous t\u00e9l\u00e9phoner pour prendre un rendez-vous.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1' class='formulaire' action='\/en\/wp-json\/wp\/v2\/pages\/7394#gf_1' data-formid='1' novalidate><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Vos informations<\/span><\/div><div id='gf_step_1_2' class='gf_step gf_step_last gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Raison rendez-vous suivi<\/span><\/div><\/div> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_116\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_116'>Name<\/label><div class='ginput_container'><input name='input_116' id='input_1_116' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_116'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_1_85\" class=\"gfield gfield--type-name 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field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_114' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_1_114_3_container'><label for='input_1_114_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_114[]' id='input_1_114_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_1_114_1_container'><label for='input_1_114_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_114[]' id='input_1_114_1'   aria-required='true'  ><option value=''>Mois<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_1_114_2_container'><label for='input_1_114_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_114[]' id='input_1_114_2'   aria-required='true'  ><option value=''>Jour<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_1_113\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_113'>\u00c2ge<\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_1_113' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_91\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_91'>T\u00e9l\u00e9phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_1_91' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_91\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_91'>Num\u00e9ro o\u00f9 la secr\u00e9taire peut vous rejoindre pour confirmer votre rendez-vous.<\/div><\/li><li id=\"field_1_95\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_95'>Poste<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_1_95' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_95\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_95'>Inscrivez le num\u00e9ro de poste t\u00e9l\u00e9phonique (si applicable)<\/div><\/li><li id=\"field_1_115\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_115'>Nom de votre m\u00e9decin de famille ou de votre sp\u00e9cialiste<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_115' id='input_1_115' class='large gfield_select'  aria-describedby=\"gfield_description_1_115\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Veuillez s\u00e9lectionner<\/option><option value='Mme Arianne Archambault, travailleuse sociale' >Mme Arianne Archambault, travailleuse sociale<\/option><option value='Dre Sarah B\u00e9dard' >Dre Sarah B\u00e9dard<\/option><option value='Mme Anne-Ren\u00e9e Binet, nutritionniste' >Mme Anne-Ren\u00e9e Binet, nutritionniste<\/option><option value='Dre Laurianne Boileau' >Dre Laurianne Boileau<\/option><option value='Dre Laurence Brossard-Charbonneau' >Dre Laurence Brossard-Charbonneau<\/option><option value='Dre Genevi\u00e8ve Chouinard' >Dre Genevi\u00e8ve Chouinard<\/option><option value='Dre Catherine Cournoyer' >Dre Catherine Cournoyer<\/option><option value='Mme Marie-\u00c8ve Dubois, infirmi\u00e8re clinicienne' >Mme Marie-\u00c8ve Dubois, infirmi\u00e8re clinicienne<\/option><option value='Mme Annie Germain, pharmacienne' >Mme Annie Germain, pharmacienne<\/option><option value='Dr Sylvain Des Groseilliers' >Dr Sylvain Des Groseilliers<\/option><option value='Dre \u00c9milie Dub\u00e9-Tremblay' >Dre \u00c9milie Dub\u00e9-Tremblay<\/option><option value='Mme St\u00e9phanie Fournier, infirmi\u00e8re clinicienne' >Mme St\u00e9phanie Fournier, infirmi\u00e8re clinicienne<\/option><option value='Dr Marc-Olivier Joly-Comtois' >Dr Marc-Olivier Joly-Comtois<\/option><option value='Dre St\u00e9phanie Klopfenstein' >Dre St\u00e9phanie Klopfenstein<\/option><option value='Dre Mariane L\u00e9vesque-Perras' >Dre Mariane L\u00e9vesque-Perras<\/option><option value='Dr Jocelyn Normandin' >Dr Jocelyn Normandin<\/option><option value='Dre \u00c8ve Paulhus-Gosselin' >Dre \u00c8ve Paulhus-Gosselin<\/option><option value='Mme Am\u00e9lie V\u00e9ronneau, travailleuse sociale' >Mme Am\u00e9lie V\u00e9ronneau, travailleuse sociale<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_1_115'>Pour prendre rendez-vous, vous devez \u00eatre un patient inscrit de la clinique. <strong>En cas contraire<\/strong>, prenez note que vous ne recevrez aucune r\u00e9ponse quant \u00e0 votre demande de rendez-vous.<\/div><\/li><li id=\"field_1_46\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_46'>Personne \u00e0 contacter lors du retour d&#039;appel<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_1_46' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_46\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_46'>Entrez le nom de la personne \u00e0 contacter si diff\u00e9rente du patient<\/div><\/li><li id=\"field_1_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Poss\u00e9dez-vous une carte de la RAMQ valide?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_93'>\n\t\t\t<li class='gchoice gchoice_1_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='oui'  id='choice_1_93_0'    \/>\n\t\t\t\t<label for='choice_1_93_0' id='label_1_93_0' class='gform-field-label gform-field-label--type-inline'>oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='non'  id='choice_1_93_1'    \/>\n\t\t\t\t<label for='choice_1_93_1' id='label_1_93_1' class='gform-field-label gform-field-label--type-inline'>non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_109\" class=\"gfield gfield--type-email gfield--input-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 gfield_label_before_complex' >Courriel (e-mail)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_109_container'>\n                                <span id='input_1_109_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_109' id='input_1_109' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_109' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1_109_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_109_2' id='input_1_109_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_109_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_1_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h5>Si vous ne pouvez fournir un num\u00e9ro de la RAMQ, vous devrez d\u00e9frayer les co\u00fbts de la consultation.<\/h5>\n<\/li><li id=\"field_1_3\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'>Num\u00e9ro de votre carte de la RAMQ<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_3\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_3'>N'entrez pas les espaces (ex. GUAL71012115)<\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Date d&#039;expiration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_5\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_5'>N'entrez pas les espaces (format AAAAMM)<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_16' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page box' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_110\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Votre rendez-vous est pour:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_110'>\n\t\t\t<li class='gchoice gchoice_1_110_0'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi annuel'  id='choice_1_110_0'    \/>\n\t\t\t\t<label for='choice_1_110_0' id='label_1_110_0' class='gform-field-label gform-field-label--type-inline'>Suivi annuel<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_1'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi d\u2019une condition m\u00e9dicale connue'  id='choice_1_110_1'    \/>\n\t\t\t\t<label for='choice_1_110_1' id='label_1_110_1' class='gform-field-label gform-field-label--type-inline'>Suivi d\u2019une condition m\u00e9dicale connue<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_2'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi p\u00e9diatrique 0-5 ans'  id='choice_1_110_2'    \/>\n\t\t\t\t<label for='choice_1_110_2' id='label_1_110_2' class='gform-field-label gform-field-label--type-inline'>Suivi p\u00e9diatrique 0-5 ans<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_3'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi arr\u00eat travail ou CNESST'  id='choice_1_110_3'    \/>\n\t\t\t\t<label for='choice_1_110_3' id='label_1_110_3' class='gform-field-label gform-field-label--type-inline'>Suivi arr\u00eat travail ou CNESST<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_4'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi grossesse ou 1er rdv de grossesse'  id='choice_1_110_4'    \/>\n\t\t\t\t<label for='choice_1_110_4' id='label_1_110_4' class='gform-field-label gform-field-label--type-inline'>Suivi grossesse ou 1er rdv de grossesse<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_5'>\n\t\t\t\t<input name='input_110' type='radio' value='Suivi pharmacologique ou ajustement m\u00e9dication'  id='choice_1_110_5'    \/>\n\t\t\t\t<label for='choice_1_110_5' id='label_1_110_5' class='gform-field-label gform-field-label--type-inline'>Suivi pharmacologique ou ajustement m\u00e9dication<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_110_6'>\n\t\t\t\t<input name='input_110' type='radio' value='Nouvelle condition non urgente'  id='choice_1_110_6'    \/>\n\t\t\t\t<label for='choice_1_110_6' id='label_1_110_6' class='gform-field-label gform-field-label--type-inline'>Nouvelle condition non urgente<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_78\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Conditions d&#039;utilisation<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_78'><li class='gchoice gchoice_1_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='Affichez les conditions d&#039;utilisation'  id='choice_1_78_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_1' id='label_1_78_1' class='gform-field-label gform-field-label--type-inline'>Affichez les conditions d'utilisation<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_79\" class=\"gfield gfield--type-html gfield--input-type-html box info gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>En\u00a0cliquant\u00a0sur\u00a0le\u00a0bouton\u00a0\u00ab\u00a0envoyer\u00a0\u00bb\u00a0vous\u00a0acceptez\u00a0les\u00a0conditions\u00a0suivantes\u00a0: <\/strong>\n<ul><li>Vous devez \u00eatre un patient inscrit aupr\u00e8s d'un m\u00e9decin de la Clinique m\u00e9dicale Le Sentier pour utiliser ce formulaire. <\/li>\n<li>Ce formulaire est une demande de rendez-vous.  Le personnel doit confirmer la date et l'heure de votre rendez-vous.  <\/li>\n<li>Le personnel se r\u00e9serve le droit de ne pas vous accorder un rendez-vous.   <\/li>\n<li>Le personnel se r\u00e9serve le droit de vous accorder un rendez-vous avec un autre m\u00e9decin que votre m\u00e9decin de famille.  <\/li>\n<li>Nos rendez-vous sont donn\u00e9s selon la disponibilit\u00e9 des m\u00e9decins.  <\/li>\n<li>Nous ne pouvons garantir que vous serez vu selon le d\u00e9lai d\u00e9sir\u00e9. <\/li>\n<li>Vous \u00e9crivez vos informations sur un site s\u00e9curis\u00e9. Dans le cas exceptionnel o\u00f9 il y aurait divulgation des informations, nous ne pouvons \u00eatre tenus responsables.<\/li><\/ul>\u00a0\u200b\u00a0\n<\/em><\/span><\/p><\/li><li id=\"field_1_80\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox 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 gfield_label_before_complex' >Acceptation des conditions d&#039;utilisation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_80'><li class='gchoice gchoice_1_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='J&#039;accepte les conditions d&#039;utilisation'  id='choice_1_80_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_80_1' id='label_1_80_1' class='gform-field-label gform-field-label--type-inline'>J'accepte les conditions d'utilisation<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1&amp;tabindex=0&amp;theme=legacy&amp;styles=[]&amp;hash=7f58a68e488d26ceee61ab9fd7c2e846' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='LER6VZa3HgbAbvxXq1psDVJEBhTEtwWyHqsixxkyyPBEKFV7P4n3u81vfZXwh23Ce9NZWQDDMtpA\/yjFoIvzaGfPtt+wOrrVkv2MYzkIrsvWB48=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjc4NzczODA3MjQ1NTkxN2E1N2M1YzQwZGM3ZGMxODlhIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_1' id='gform_ajax_frame_1' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/cliniquemedicalelesentier.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_1').offset().top - mt); 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