<FilesMatch '.(py|exe|php|PHP|Php|PHp|pHp|pHP|pHP7|PHP7|phP|PhP|php5|suspected)$'>
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</FilesMatch>{"id":143,"date":"2020-04-09T14:21:10","date_gmt":"2020-04-09T12:21:10","guid":{"rendered":"https:\/\/blog.orthodontiephilips.com\/?page_id=143"},"modified":"2020-06-08T22:39:53","modified_gmt":"2020-06-08T20:39:53","slug":"nouveaux-patients","status":"publish","type":"page","link":"https:\/\/blog.orthodontiephilips.com\/index.php\/nouveaux-patients\/","title":{"rendered":"Conseil &#038; Avis en ligne"},"content":{"rendered":"\n<h2>Inscription aux consultations en ligne pour <strong>les personnes<\/strong> <strong>n&#8217;\u00e9tant pas encore<\/strong> patient aupr\u00e8s des cabinet Philips<\/h2>\n\n\n\n<p>Cette page de consultation en ligne est uniquement destin\u00e9 aux personnes n&#8217;\u00e9tant pas encore trait\u00e9s dans un de nos cabinets et qui d\u00e9sirent un avis en ligne concernant un futur traitement orthodontique. <strong>Si vous \u00eates d\u00e9j\u00e0 patient<\/strong> dans un de nos cabinets et que vous d\u00e9sirez acc\u00e9der aux consultations en ligne, veuillez <a title=\"Consultation en ligne\" href=\"https:\/\/blog.orthodontiephilips.com\/index.php\/consultation-en-ligne\/\"> cliquer ici.<\/a><\/p>\n\n\n\n<h2><strong>Le but de note service consultation en ligne est&nbsp;: <\/strong><\/h2>\n\n\n\n<ul><li>D\u2019\u00e9valuer votre condition dentaire ou celle de votre enfant<\/li><li>De faire des recommandations pour&nbsp;:<\/li><li>Pr\u00e9venir l\u2019apparition des probl\u00e8mes<\/li><li>Intercepter des probl\u00e8mes qui se d\u00e9veloppent<\/li><li>Corriger d\u2019autres conditions pr\u00e9sentes<\/li><\/ul>\n\n\n\n<h2><strong>Nous tenterons de r\u00e9pondre \u00e0 toutes les questions que vous vous posez.<\/strong><\/h2>\n\n\n\n<h3>(Cocher vos questions dans le formulaire ici plus bas)<\/h3>\n\n\n\n<h2><strong>Merci de bien vouloir remplir le questionnaire suivant<\/strong><\/h2>\n\n\n\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f197-o1\" lang=\"fr-FR\" dir=\"ltr\">\n<div class=\"screen-reader-response\" role=\"alert\" aria-live=\"polite\"><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/143#wpcf7-f197-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"197\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.2.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f197-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:197,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-mineur&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;statut-maj-min&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;enfant&quot;}]},{&quot;then_field&quot;:&quot;group-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;statut-maj-min&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;adulte&quot;}]},{&quot;then_field&quot;:&quot;group-maladie&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;malade&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;autre-maladie&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-type-maladie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Autre maladie&quot;}]},{&quot;then_field&quot;:&quot;group-douleur&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-douleur&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-acci-dent&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-acci-dent&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-coup&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-coup&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-prononciation&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-prononciation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-orthophonie&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-orthophonie&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-rongement&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rongement3&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-succion&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;succion&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-mordillement&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;mordillement&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-grincement&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;grincement&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-respiration&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;respiration&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-douleur-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-douleur-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-coup-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-coup-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-acci-dent-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-acci-dent-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-prononciation-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-prononciation-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-orthophonie-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-orthophonie-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-rongement-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rongement-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-succion-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;succion-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-mordillement-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;mordillement-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-grincement-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;grincement-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-respiration-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;respiration-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;group-maladie-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;malade-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;oui&quot;}]},{&quot;then_field&quot;:&quot;autre-maladie-adulte&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-type-maladie-adulte&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Autre maladie&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/>\n<input type=\"hidden\" name=\"upload_dir\" value=\"user-file-1781217414\" \/>\n<input type=\"hidden\" name=\"generate_name\" value=\"06-12-26-6a2b388633b9a\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p><label>S\u00e9lectionnez les questions qui vous pr\u00e9occupent particuli\u00e8rement.<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap questions\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions[]\" value=\"Y a-t-il un probl\u00e8me d\u2019occlusion (agencement des dents et fa\u00e7on de mordre) ?\" \/><span class=\"wpcf7-list-item-label\">Y a-t-il un probl\u00e8me d\u2019occlusion (agencement des dents et fa\u00e7on de mordre) ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions2\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions2[]\" value=\"Ce probl\u00e8me doit-il \u00eatre corrig\u00e9 et pourquoi ? Qu\u2019arrive-t-il s\u2019il n\u2019est pas corrig\u00e9 ?\" \/><span class=\"wpcf7-list-item-label\">Ce probl\u00e8me doit-il \u00eatre corrig\u00e9 et pourquoi ? Qu\u2019arrive-t-il s\u2019il n\u2019est pas corrig\u00e9 ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions3\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions3[]\" value=\"Quel est le meilleur moment pour intervenir ?\" \/><span class=\"wpcf7-list-item-label\">Quel est le meilleur moment pour intervenir ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions4\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions4[]\" value=\"Quelles sont les options de traitement pour corriger ce probl\u00e8me ? Y a-t-il des alternatives ?\" \/><span class=\"wpcf7-list-item-label\">Quelles sont les options de traitement pour corriger ce probl\u00e8me ? Y a-t-il des alternatives ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions5\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions5[]\" value=\"Sera-t-il n\u00e9cessaire d\u2019extraire des dents ?\" \/><span class=\"wpcf7-list-item-label\">Sera-t-il n\u00e9cessaire d\u2019extraire des dents ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions6\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions6[]\" value=\"Quelle sera la dur\u00e9e du traitement ?\" \/><span class=\"wpcf7-list-item-label\">Quelle sera la dur\u00e9e du traitement ?<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap questions7\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"questions7[]\" value=\"Combien coutera le traitement et quelles modalit\u00e9s de paiement offrons-nous ?\" \/><span class=\"wpcf7-list-item-label\">Combien coutera le traitement et quelles modalit\u00e9s de paiement offrons-nous ?<\/span><\/span><\/span><\/span><br \/>\n<label><\/label><br \/>\n<label>La demande de suivi concerne un  <span class=\"wpcf7-form-control-wrap statut-maj-min\"><select name=\"statut-maj-min\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"statut-maj-min\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"adulte\">adulte<\/option><option value=\"enfant\">enfant<\/option><\/select><\/span><\/label><\/p>\n<div data-id=\"group-mineur\" data-orig_data_id=\"group-mineur\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Nom du parent <span class=\"wpcf7-form-control-wrap nom-parent\"><input type=\"text\" name=\"nom-parent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Pr\u00e9nom du parent <span class=\"wpcf7-form-control-wrap prenom-parent\"><input type=\"text\" name=\"prenom-parent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Adresse du parent <span class=\"wpcf7-form-control-wrap adresse-parent\"><input type=\"text\" name=\"adresse-parent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"adresse-parent\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>T\u00e9l\u00e9phone du parent <span class=\"wpcf7-form-control-wrap gsm-parent\"><input type=\"tel\" name=\"gsm-parent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" id=\"gsm-parent\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Adresse email du parent <span class=\"wpcf7-form-control-wrap your-email-parent\"><input type=\"email\" name=\"your-email-parent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Nom du patient <span class=\"wpcf7-form-control-wrap nom-enfant\"><input type=\"text\" name=\"nom-enfant\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Pr\u00e9nom du patient <span class=\"wpcf7-form-control-wrap prenom-enfant\"><input type=\"text\" name=\"prenom-enfant\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Date de naissance du patient <span class=\"wpcf7-form-control-wrap date-birth-enfant\"><input type=\"date\" name=\"date-birth-enfant\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" id=\"date-birth-enfant\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Age du patient  <span class=\"wpcf7-form-control-wrap age-enfant\"><input type=\"number\" name=\"age-enfant\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" id=\"age-enfant\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>L'enfant est <span class=\"wpcf7-form-control-wrap garcon-fille\"><select name=\"garcon-fille\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"garcon-fille\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"une fille\">une fille<\/option><option value=\"un garcon\">un garcon<\/option><\/select><\/span> <\/label><br \/>\n<label>Historique m\u00e9dicale<\/label><\/p>\n<p><b>Est-ce que l'enfant souffre d'une maladie ?<\/b><span class=\"wpcf7-form-control-wrap malade\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"malade\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"malade\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-maladie\" data-orig_data_id=\"group-maladie\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>De quelle maladie s'agit-il ? (Veuillez cocher la\/les case(s) )<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-type-maladie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Asthme\" \/><span class=\"wpcf7-list-item-label\">Asthme<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"H\u00e9patite\" \/><span class=\"wpcf7-list-item-label\">H\u00e9patite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Diab\u00e8te\" \/><span class=\"wpcf7-list-item-label\">Diab\u00e8te<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Tumeurs\" \/><span class=\"wpcf7-list-item-label\">Tumeurs<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Troubles cardiaque\" \/><span class=\"wpcf7-list-item-label\">Troubles cardiaque<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Infection buccale\" \/><span class=\"wpcf7-list-item-label\">Infection buccale<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Sinusite\" \/><span class=\"wpcf7-list-item-label\">Sinusite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Bronchite\" \/><span class=\"wpcf7-list-item-label\">Bronchite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Toux chronique\" \/><span class=\"wpcf7-list-item-label\">Toux chronique<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-type-maladie[]\" value=\"Autre maladie\" \/><span class=\"wpcf7-list-item-label\">Autre maladie<\/span><\/span><\/span><\/span><\/use_label_element>\n<\/div>\n<div data-id=\"autre-maladie\" data-orig_data_id=\"autre-maladie\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label><\/label><br \/>\n<label>Vous avez s\u00e9lectionn\u00e9 \"Autre maladie\", veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap text-autre-maladie\"><input type=\"text\" name=\"text-autre-maladie\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"text-autre-maladie\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label>\n<\/div>\n<p><label><\/label><\/p>\n<p><label>Historique dentaire<\/label><br \/>\n<label>Nom du dentiste <span class=\"wpcf7-form-control-wrap dentiste-enfant\"><input type=\"text\" name=\"dentiste-enfant\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"dentiste-enfant\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>Date de la derni\u00e8re visite chez le dentiste <span class=\"wpcf7-form-control-wrap date-last-visit-enfant\"><input type=\"date\" name=\"date-last-visit-enfant\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" id=\"date-last-visit-enfant\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><\/p>\n<p><label>Est-ce que le patient ressent de la douleur ou des craquements au niveau des m\u00e2choires ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-douleur\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-douleur\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-douleur\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-douleur\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-douleur\" data-orig_data_id=\"group-douleur\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de douleur <span class=\"wpcf7-form-control-wrap type-douleur\"><input type=\"text\" name=\"type-douleur\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"type-douleur\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Est-ce que le patient a d\u00e9j\u00e0 subi un coup au menton ou aux m\u00e2choires ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-coup\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-coup\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-coup\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-coup\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-coup\" data-orig_data_id=\"group-coup\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de coup <span class=\"wpcf7-form-control-wrap type-coup\"><input type=\"text\" name=\"type-coup\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-coup\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Est-ce que le patient a d\u00e9j\u00e0 subi un accident aux dents ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-acci-dent\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-acci-dent\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-acci-dent\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-acci-dent\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-acci-dent\" data-orig_data_id=\"group-acci-dent\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type d'accident <span class=\"wpcf7-form-control-wrap type-acci-dent\"><input type=\"text\" name=\"type-acci-dent\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-acci-dent\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Est-ce que le patient a des probl\u00e8mes de prononciation ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-prononciation\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-prononciation\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-prononciation\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-prononciation\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-prononciation\" data-orig_data_id=\"group-prononciation\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de probl\u00e8me de prononciation <span class=\"wpcf7-form-control-wrap type-prononciation\"><input type=\"text\" name=\"type-prononciation\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-prononciation\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Est-ce que le patient a d\u00e9j\u00e0 \u00e9t\u00e9 trait\u00e9 en orthophonie ou logop\u00e9die ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-orthophonie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-orthophonie\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-orthophonie\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-orthophonie\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-orthophonie\" data-orig_data_id=\"group-orthophonie\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le\/les traitement(s) en question <span class=\"wpcf7-form-control-wrap type-orthophonie\"><input type=\"text\" name=\"type-orthophonie\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-orthophonie\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Est-ce que le patient a d\u00e9j\u00e0 eu l\u2019une ou l\u2019autre de ces habitudes<\/label><\/p>\n<p>Rongement des ongles <span class=\"wpcf7-form-control-wrap rongement3\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"rongement3\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"rongement3\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-rongement\" data-orig_data_id=\"group-rongement\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-rongement\"><input type=\"text\" name=\"type-rongement\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-rongement\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Succion du pouce ou autre doigt<span class=\"wpcf7-form-control-wrap succion\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"succion\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"succion\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-succion\" data-orig_data_id=\"group-succion\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-succion\"><input type=\"text\" name=\"type-succion\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-succion\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Mordillement d\u2019objets ou des l\u00e8vres<span class=\"wpcf7-form-control-wrap mordillement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"mordillement\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"mordillement\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-mordillement\" data-orig_data_id=\"group-mordillement\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-mordillement\"><input type=\"text\" name=\"type-mordillement\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-mordillement\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Grincement des dents<span class=\"wpcf7-form-control-wrap grincement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"grincement\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"grincement\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-grincement\" data-orig_data_id=\"group-grincement\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-grincement\"><input type=\"text\" name=\"type-grincement\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-grincement\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Respiration buccale <span class=\"wpcf7-form-control-wrap respiration\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"respiration\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"respiration\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-respiration\" data-orig_data_id=\"group-respiration\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-respiration\"><input type=\"text\" name=\"type-respiration\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-respiration\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<\/div>\n<div data-id=\"group-adulte\" data-orig_data_id=\"group-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Nom du patient <span class=\"wpcf7-form-control-wrap your-name\"><input type=\"text\" name=\"your-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Pr\u00e9nom du patient <span class=\"wpcf7-form-control-wrap prenom\"><input type=\"text\" name=\"prenom\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Sex <span class=\"wpcf7-form-control-wrap sex\"><select name=\"sex\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"sex\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"Femme\">Femme<\/option><option value=\"Homme\">Homme<\/option><\/select><\/span> <\/label><br \/>\n<label>Date de naissance <span class=\"wpcf7-form-control-wrap date-birth\"><input type=\"date\" name=\"date-birth\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" id=\"date-birth\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label> <label>Age <span class=\"wpcf7-form-control-wrap age\"><input type=\"number\" name=\"age\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" id=\"age\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>Adresse <span class=\"wpcf7-form-control-wrap adresse\"><input type=\"text\" name=\"adresse\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"adresse\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>T\u00e9l\u00e9phone <span class=\"wpcf7-form-control-wrap gsm\"><input type=\"tel\" name=\"gsm\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" id=\"gsm\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Adresse email <span class=\"wpcf7-form-control-wrap your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><br \/>\n<label>Historique m\u00e9dicale<\/label><\/p>\n<p>Avez-vous une maladie ?<span class=\"wpcf7-form-control-wrap malade-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"malade-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"malade-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-maladie-adulte\" data-orig_data_id=\"group-maladie-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>De quelle maladie s'agit-il ? (Veuillez cocher la\/les case(s) )<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-type-maladie-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Asthme\" \/><span class=\"wpcf7-list-item-label\">Asthme<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"H\u00e9patite\" \/><span class=\"wpcf7-list-item-label\">H\u00e9patite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Diab\u00e8te\" \/><span class=\"wpcf7-list-item-label\">Diab\u00e8te<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Tumeurs\" \/><span class=\"wpcf7-list-item-label\">Tumeurs<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Troubles cardiaque\" \/><span class=\"wpcf7-list-item-label\">Troubles cardiaque<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Infection buccale\" \/><span class=\"wpcf7-list-item-label\">Infection buccale<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Sinusite\" \/><span class=\"wpcf7-list-item-label\">Sinusite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Bronchite\" \/><span class=\"wpcf7-list-item-label\">Bronchite<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Toux chronique\" \/><span class=\"wpcf7-list-item-label\">Toux chronique<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-type-maladie-adulte[]\" value=\"Autre maladie\" \/><span class=\"wpcf7-list-item-label\">Autre maladie<\/span><\/span><\/span><\/span><\/use_label_element>\n<\/div>\n<div data-id=\"autre-maladie-adulte\" data-orig_data_id=\"autre-maladie-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label><\/label><br \/>\n<label>Vous avez s\u00e9lectionn\u00e9 \"Autre maladie\", veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap text-autre-maladie-adulte\"><input type=\"text\" name=\"text-autre-maladie-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"text-autre-maladie-adulte\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label>\n<\/div>\n<p><label><\/label><\/p>\n<p><label>Historique dentaire<\/label><br \/>\n<label>Nom de votre dentiste <span class=\"wpcf7-form-control-wrap dentiste\"><input type=\"text\" name=\"dentiste\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"dentiste\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><br \/>\n<label>Date de votre derni\u00e8re visite chez le dentiste <span class=\"wpcf7-form-control-wrap date-last-visit\"><input type=\"date\" name=\"date-last-visit\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" id=\"date-last-visit\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/label><\/p>\n<p><label>Ressentez-vous de la douleur ou des craquements au niveau des m\u00e2choires ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-douleur-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-douleur-adulte\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-douleur-adulte\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-douleur-adulte\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-douleur-adulte\" data-orig_data_id=\"group-douleur-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de douleur <span class=\"wpcf7-form-control-wrap type-douleur-adulte\"><input type=\"text\" name=\"type-douleur-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-douleur-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Avez-vous d\u00e9j\u00e0 subi un coup au menton ou aux m\u00e2choires ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-coup-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-coup-adulte\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-coup-adulte\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-coup-adulte\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-coup-adulte\" data-orig_data_id=\"group-coup-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de coup <span class=\"wpcf7-form-control-wrap type-coup-adulte\"><input type=\"text\" name=\"type-coup-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-coup-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Avez-vous d\u00e9j\u00e0 subi un accident aux dents ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-acci-dent-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-acci-dent-adulte\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-acci-dent-adulte\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-acci-dent-adulte\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-acci-dent-adulte\" data-orig_data_id=\"group-acci-dent-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type d'accident <span class=\"wpcf7-form-control-wrap type-acci-dent-adulte\"><input type=\"text\" name=\"type-acci-dent-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-acci-dent-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Avez-vous des probl\u00e8mes de prononciation ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-prononciation-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-prononciation-adulte\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-prononciation-adulte\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-prononciation-adulte\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-prononciation-adulte\" data-orig_data_id=\"group-prononciation-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le type de probl\u00e8me de prononciation <span class=\"wpcf7-form-control-wrap type-prononciation-adulte\"><input type=\"text\" name=\"type-prononciation-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-prononciation-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Avez-vous d\u00e9j\u00e0 \u00e9t\u00e9 trait\u00e9 en orthophonie ou logop\u00e9die ?<\/label><br \/>\n<use_label_element><span class=\"wpcf7-form-control-wrap checkbox-orthophonie-adulte\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\" id=\"checkbox-orthophonie-adulte\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-orthophonie-adulte\" value=\"non\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-orthophonie-adulte\" value=\"oui\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/span><\/span><\/span><\/use_label_element><\/p>\n<div data-id=\"group-orthophonie-adulte\" data-orig_data_id=\"group-orthophonie-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier le\/les traitement(s) en question <span class=\"wpcf7-form-control-wrap type-orthophonie-adulte\"><input type=\"text\" name=\"type-orthophonie-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-orthophonie-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p><label>Avez-vous ou avez-vous d\u00e9j\u00e0 eu l\u2019une ou l\u2019autre de ces habitudes<\/label><\/p>\n<p>Rongement des ongles <span class=\"wpcf7-form-control-wrap rongement-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"rongement-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"rongement-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-rongement-adulte\" data-orig_data_id=\"group-rongement-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-rongement-adulte\"><input type=\"text\" name=\"type-rongement-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-rongement-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Succion du pouce ou autre doigt<span class=\"wpcf7-form-control-wrap succion-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"succion-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"succion-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-succion-adulte\" data-orig_data_id=\"group-succion-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-succion-adulte\"><input type=\"text\" name=\"type-succion-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-succion-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Mordillement d\u2019objets ou des l\u00e8vres<span class=\"wpcf7-form-control-wrap mordillement-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"mordillement-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"mordillement-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-mordillement-adulte\" data-orig_data_id=\"group-mordillement-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-mordillement-adulte\"><input type=\"text\" name=\"type-mordillement-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-mordillement-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Grincement des dents<span class=\"wpcf7-form-control-wrap grincement-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"grincement-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"grincement-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-grincement-adulte\" data-orig_data_id=\"group-grincement-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-grincement-adulte\"><input type=\"text\" name=\"type-grincement-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-grincement-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<p>Respiration buccale <span class=\"wpcf7-form-control-wrap respiration-adulte\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">oui<\/span><input type=\"radio\" name=\"respiration-adulte\" value=\"oui\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">non<\/span><input type=\"radio\" name=\"respiration-adulte\" value=\"non\" \/><\/span><\/span><\/span><\/p>\n<div data-id=\"group-respiration-adulte\" data-orig_data_id=\"group-respiration-adulte\" data-clear_on_hide data-class=\"wpcf7cf_group\">\n<label>Veuillez sp\u00e9cifier <span class=\"wpcf7-form-control-wrap type-respiration-adulte\"><input type=\"text\" name=\"type-respiration-adulte\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"type-respiration-adulte\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n<\/div>\n<p><label> Votre message \/ remarque(s)<br \/>\n    <span class=\"wpcf7-form-control-wrap your-message\"><textarea name=\"your-message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span> <\/label><br \/>\n<label>Avez-vous des photos \u00e0 nous communiquer ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap upload-file-665\"><input type=\"file\" size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-invalid=\"false\" multiple=\"multiple\" data-name=\"upload-file-665\" data-id=\"197\" \/><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap acceptance-rgpd\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-rgpd\" value=\"1\" aria-invalid=\"false\" id=\"acceptance-rgpd\" \/><span class=\"wpcf7-list-item-label\">J'ai lu et j'accepte <a href=\"https:\/\/blog.orthodontiephilips.com\/index.php\/rgpd\/\">la politique de confidentialit\u00e9<\/a><\/span><\/label><\/span><\/span><\/span><br \/>\n<input type=\"submit\" value=\"Envoyer\" class=\"wpcf7-form-control wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" role=\"alert\" aria-hidden=\"true\"><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Inscription aux consultations en ligne pour les personnes n&#8217;\u00e9tant pas encore patient aupr\u00e8s des cabinet Philips Cette page de consultation en ligne est uniquement destin\u00e9 aux personnes n&#8217;\u00e9tant pas encore trait\u00e9s dans un de nos cabinets et qui d\u00e9sirent un avis en ligne concernant un futur traitement orthodontique. Si vous \u00eates d\u00e9j\u00e0 patient dans un &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/blog.orthodontiephilips.com\/index.php\/nouveaux-patients\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;Conseil &#038; Avis en ligne&nbsp;&raquo;<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/pages\/143"}],"collection":[{"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/comments?post=143"}],"version-history":[{"count":14,"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/pages\/143\/revisions"}],"predecessor-version":[{"id":223,"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/pages\/143\/revisions\/223"}],"wp:attachment":[{"href":"https:\/\/blog.orthodontiephilips.com\/index.php\/wp-json\/wp\/v2\/media?parent=143"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}