{"id":134,"date":"2016-06-30T20:55:05","date_gmt":"2016-06-30T19:55:05","guid":{"rendered":"https:\/\/chironetwork.com\/en\/?page_id=134"},"modified":"2022-07-18T08:41:08","modified_gmt":"2022-07-18T12:41:08","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/chironetwork.com\/en\/appointment\/book-an-appointment\/","title":{"rendered":"Book an appointment"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2887-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"2887\">\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\/134#wpcf7-f2887-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2887\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2887-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div id=\"appointment-form\">\n\t<div class=\"group-wrap clearfix\">\n\t\t<p>Call at <strong>(819)777-0577<\/strong> to book your first appointment or fill out the form below:\n\t\t<\/p>\n\t\t<h4 class=\"title\">Reason of the visit\n\t\t<\/h4>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"raison\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"raison\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"group-wrap clearfix\">\n\t\t<h4 class=\"title\">New patient or active patient?*\n\t\t<\/h4>\n\t\t<div class=\"field-wrap field-patient\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"patient\" value=\"New patient\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">New patient<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"patient\" value=\"Old patient who wishes to reactivate his file\" \/><span class=\"wpcf7-list-item-label\">Old patient who wishes to reactivate his file<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"group-wrap clearfix\">\n\t\t<h3 class=\"title\">CONTACT INFORMATIONS\n\t\t<\/h3>\n\t\t<div class=\"row-wrap clearfix\">\n\t\t\t<h4 class=\"title\">Name*\n\t\t\t<\/h4>\n\t\t\t<div class=\"field-wrap field-name\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-fname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient first name\" value=\"\" type=\"text\" name=\"patient-fname\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field-wrap field-name\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-lname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient last name\" value=\"\" type=\"text\" name=\"patient-lname\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"row-wrap clearfix\">\n\t\t\t<h4 class=\"title\">Your name (if different from patient)\n\t\t\t<\/h4>\n\t\t\t<div class=\"field-wrap field-name\">\n\t\t\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\" placeholder=\"Your first name\" value=\"\" type=\"text\" name=\"fname\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field-wrap field-name\">\n\t\t\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\" placeholder=\"Your last name\" value=\"\" type=\"text\" name=\"lname\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-wrap field-tel\">\n\t\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\" placeholder=\"Phone number*\" value=\"\" type=\"text\" name=\"phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field-wrap field-email\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"courriel\"><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\" placeholder=\"Email*\" value=\"\" type=\"email\" name=\"courriel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row-wrap clearfix\">\n\t\t<h4 class=\"title\">Reference\n\t\t<\/h4>\n\t\t<div class=\"field-wrap field-name\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"reference-fname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Reference first name\" value=\"\" type=\"text\" name=\"reference-fname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field-wrap field-name\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"reference-lname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Reference last name\" value=\"\" type=\"text\" name=\"reference-lname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"group-wrap clearfix\">\n\t\t<h3 class=\"title\">APPOINTMENT REQUEST*\n\t\t<\/h3>\n\t\t<p>Please select your preferred time slot. One of our assistants will contact you as soon as possible to confirm your appointment.\n\t\t<\/p>\n\t\t<div class=\"row-wrap clearfix\">\n\t\t\t<div class=\"field-wrap field-date\">\n\t\t\t\t<h4>Which day do you prefer?\n\t\t\t\t<\/h4>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"jour-prefere\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"jour-prefere\"><option value=\"Monday\">Monday<\/option><option value=\"Tuesday\">Tuesday<\/option><option value=\"Wednesday\">Wednesday<\/option><option value=\"Thursday\">Thursday<\/option><option value=\"As soon as possible\">As soon as possible<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field-wrap field-date\">\n\t\t\t\t<h4>Which time do you prefer?\n\t\t\t\t<\/h4>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plage-horaire-preferee\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"plage-horaire-preferee\"><option value=\"Morning\">Morning<\/option><option value=\"Noon\">Noon<\/option><option value=\"Evening\">Evening<\/option><option value=\"No matter\">No matter<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SUBMIT\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":44,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-page.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-134","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/pages\/134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/comments?post=134"}],"version-history":[{"count":5,"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/pages\/134\/revisions"}],"predecessor-version":[{"id":2889,"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/pages\/134\/revisions\/2889"}],"up":[{"embeddable":true,"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/pages\/44"}],"wp:attachment":[{"href":"https:\/\/chironetwork.com\/en\/wp-json\/wp\/v2\/media?parent=134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}