{"id":945,"date":"2022-03-24T10:52:48","date_gmt":"2022-03-24T14:52:48","guid":{"rendered":"https:\/\/heatherveltman.com\/?page_id=945"},"modified":"2022-06-20T13:45:53","modified_gmt":"2022-06-20T17:45:53","slug":"formulaire-pre-rencontre","status":"publish","type":"page","link":"https:\/\/heatherveltman.com\/formulaire-pre-rencontre\/","title":{"rendered":"Formulaire pr\u00e9-rencontre"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"945\" class=\"elementor elementor-945\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-870e11d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"870e11d\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-156d320\" data-id=\"156d320\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0b71233 elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"0b71233\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 09-10-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Formulaire pr\u00e9-rencontre<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-734bde6 elementor-widget elementor-widget-text-editor\" data-id=\"734bde6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 09-10-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Merci de remplir ce formulaire avant notre premi\u00e8re rencontre. Je pourrai aller plus vite dans l\u2019\u00e9valuation de tes besoins et cr\u00e9er un service personnalis\u00e9.\u00a0\u00a0<\/p><p>\u00a0<\/p><p>Tu auras acc\u00e8s \u00e0 mon calendrier pour prendre un premier rendez-vous.\u00a0\u00a0<\/p><p>\u00a0<\/p><p>Toutes les r\u00e9ponses dans ce formulaire sont strictement confidentielles. Je suis la seule personne qui aura acc\u00e8s \u00e0 ce document. Nous pourrons approfondir durant notre rendez-vous.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-10234c1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"10234c1\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-61e87f5\" data-id=\"61e87f5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4ea7d47 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"4ea7d47\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;step_type&quot;:&quot;number&quot;,&quot;step_icon_shape&quot;:&quot;none&quot;,&quot;button_width&quot;:&quot;100&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor-pro - v3.16.0 - 20-09-2023 *\/\n.elementor-button.elementor-hidden,.elementor-hidden{display:none}.e-form__step{width:100%}.e-form__step:not(.elementor-hidden){display:flex;flex-wrap:wrap}.e-form__buttons{flex-wrap:wrap}.e-form__buttons,.e-form__buttons__wrapper{display:flex}.e-form__indicators{display:flex;justify-content:space-between;align-items:center;flex-wrap:nowrap;font-size:13px;margin-bottom:var(--e-form-steps-indicators-spacing)}.e-form__indicators__indicator{display:flex;flex-direction:column;align-items:center;justify-content:center;flex-basis:0;padding:0 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.e-font-icon-svg{height:1em}.e-form__indicators__indicator__number{width:var(--e-form-steps-indicator-padding,30px);height:var(--e-form-steps-indicator-padding,30px);border-width:1px;border-style:solid;display:flex;justify-content:center;align-items:center;margin-bottom:10px}.e-form__indicators__indicator--shape-circle{border-radius:50%}.e-form__indicators__indicator--shape-square{border-radius:0}.e-form__indicators__indicator--shape-rounded{border-radius:5px}.e-form__indicators__indicator--shape-none{border:0}.e-form__indicators__indicator__label{text-align:center}.e-form__indicators__indicator__separator{width:100%;height:var(--e-form-steps-divider-width);background-color:#babfc5}.e-form__indicators--type-icon,.e-form__indicators--type-icon_text,.e-form__indicators--type-number,.e-form__indicators--type-number_text{align-items:flex-start}.e-form__indicators--type-icon .e-form__indicators__indicator__separator,.e-form__indicators--type-icon_text .e-form__indicators__indicator__separator,.e-form__indicators--type-number .e-form__indicators__indicator__separator,.e-form__indicators--type-number_text .e-form__indicators__indicator__separator{margin-top:calc(var(--e-form-steps-indicator-padding, 30px) \/ 2 - var(--e-form-steps-divider-width, 1px) \/ 2)}.elementor-field-type-hidden{display:none}.elementor-field-type-html{display:inline-block}.elementor-login .elementor-lost-password,.elementor-login .elementor-remember-me{font-size:.85em}.elementor-field-type-recaptcha_v3 .elementor-field-label{display:none}.elementor-field-type-recaptcha_v3 .grecaptcha-badge{z-index:1}.elementor-button .elementor-form-spinner{order:3}.elementor-form .elementor-button>span{display:flex;justify-content:center;align-items:center}.elementor-form .elementor-button .elementor-button-text{white-space:normal;flex-grow:0}.elementor-form .elementor-button svg{height:auto}.elementor-form .elementor-button .e-font-icon-svg{height:1em}.elementor-select-wrapper .select-caret-down-wrapper{position:absolute;top:50%;transform:translateY(-50%);inset-inline-end:10px;pointer-events:none;font-size:11px}.elementor-select-wrapper .select-caret-down-wrapper svg{display:unset;width:1em;aspect-ratio:unset;fill:currentColor}.elementor-select-wrapper .select-caret-down-wrapper i{font-size:19px;line-height:2}.elementor-select-wrapper.remove-before:before{content:\"\"!important}<\/style>\t\t<form class=\"elementor-form\" method=\"post\" id=\"prerencontre\" name=\"Formulaire pr\u00e9-rencontre\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"945\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"4ea7d47\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Dr. Heather Veltman\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-page1 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Page 1\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-prenom elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-prenom\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[prenom]\" id=\"form-field-prenom\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Pr\u00e9nom\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-nom elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-nom\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[nom]\" id=\"form-field-nom\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Nom\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-tel elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-tel\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNum\u00e9ro de t\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[tel]\" id=\"form-field-tel\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Num\u00e9ro de t\u00e9l\u00e9phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCourriel\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Courriel\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-adresse elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-adresse\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[adresse]\" id=\"form-field-adresse\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Adresse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-profession elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-profession\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProfession ou occupation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[profession]\" id=\"form-field-profession\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Profession ou occupation\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-couple elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-couple\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEn couple\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[couple]\" id=\"form-field-couple\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"En couple et si oui, depuis combien de temps\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-enfant elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-enfant\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEnfants\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[enfant]\" id=\"form-field-enfant\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Enfants et si oui, leur \u00e2ge et leur sexe\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-trouvee elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-trouvee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tComment m'as-tu trouv\u00e9e?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[trouvee]\" id=\"form-field-trouvee\" class=\"elementor-field-textual elementor-size-lg\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\"\">S\u00e9lectionner...<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Facebook\">Facebook<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Instagram\">Instagram<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Google\">Google<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Site web\">Site web<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"R\u00e9f\u00e9rence personnelle\">R\u00e9f\u00e9rence personnelle<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Autres\">Autres<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-page2 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Page 2\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-objectif elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-objectif\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tObjectifs (cocher et expliquer)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mieux aimer mon corps de femme\" id=\"form-field-objectif-0\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-0\">Mieux aimer mon corps de femme<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Me sentir belle\" id=\"form-field-objectif-1\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-1\">Me sentir belle<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Travailler mon estime de soi\" id=\"form-field-objectif-2\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-2\">Travailler mon estime de soi<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Diminuer mon anxi\u00e9t\u00e9\" id=\"form-field-objectif-3\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-3\">Diminuer mon anxi\u00e9t\u00e9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Augmenter ma joie de vivre\" id=\"form-field-objectif-4\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-4\">Augmenter ma joie de vivre<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sentir mon pouvoir personnel\" id=\"form-field-objectif-5\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-5\">Sentir mon pouvoir personnel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Apprendre \u00e0 dire non (ou oui!)\" id=\"form-field-objectif-6\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-6\">Apprendre \u00e0 dire non (ou oui!)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"D\u00e9velopper ma cr\u00e9ativit\u00e9 et mon oeil d\u2019artiste\" id=\"form-field-objectif-7\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-7\">D\u00e9velopper ma cr\u00e9ativit\u00e9 et mon oeil d\u2019artiste<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Voir plus clair dans mes projets et mes r\u00eaves\" id=\"form-field-objectif-8\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-8\">Voir plus clair dans mes projets et mes r\u00eaves<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tomber en amour avec moi-m\u00eame et les autres\" id=\"form-field-objectif-9\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-9\">Tomber en amour avec moi-m\u00eame et les autres<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Vivre des beaux moments d\u2019intimit\u00e9 amoureuse\" id=\"form-field-objectif-10\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-10\">Vivre des beaux moments d\u2019intimit\u00e9 amoureuse<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autres (d\u00e9crire)\" id=\"form-field-objectif-11\" name=\"form_fields[objectif][]\"> <label for=\"form-field-objectif-11\">Autres (d\u00e9crire)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_18da280 elementor-col-50\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_18da280]\" id=\"form-field-field_18da280\" rows=\"2\" placeholder=\"Expliquer votre choix\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-symptome elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-symptome\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSympt\u00f4mes caus\u00e9s par mes difficult\u00e9s ou mes d\u00e9fis\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[symptome]\" id=\"form-field-symptome\" rows=\"3\" placeholder=\"D\u00e9crivez vos sympt\u00f4mes\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-contexte elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-contexte\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContexte et historique du probl\u00e8me\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[contexte]\" id=\"form-field-contexte\" rows=\"3\" placeholder=\"Quand, comment \u00e7a se passe et depuis combien de temps\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-histoire elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-histoire\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHistoire familiale\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[histoire]\" id=\"form-field-histoire\" rows=\"3\" placeholder=\"D\u00e9crivez bri\u00e8vement vos dynamiques familiales: relation avec votre m\u00e8re, votre p\u00e8re, votre fratrie\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-conditionmed elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-conditionmed\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCondition m\u00e9dicale ou diagnostic \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[conditionmed]\" id=\"form-field-conditionmed\" rows=\"3\" placeholder=\"Condition m\u00e9dicale ou diagnostic \"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-medicaments elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-medicaments\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPrise de m\u00e9dicaments \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[medicaments]\" id=\"form-field-medicaments\" rows=\"3\" placeholder=\"Pour traiter quelle condition?\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-consul_anterieur elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-consul_anterieur\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tConsultations ant\u00e9rieures en psychoth\u00e9rapie \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[consul_anterieur]\" id=\"form-field-consul_anterieur\" rows=\"3\" placeholder=\"Exp\u00e9rience positive ou n\u00e9gative?\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-page3 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Page 3\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b796748 elementor-col-100\">\n\t\t\t\t\t<h4 style=\"text-align:center;\">Lifestyle: aide-moi \u00e0 conna\u00eetre tes habitudes et ta vie<\/h4>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_caa7908 elementor-col-100\">\n\t\t\t\t\t<h5 style=\"color:#F58981; text-align:center\">Relations interpersonnelles<\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-orientation elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-orientation\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOrientation sexuelle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[orientation]\" id=\"form-field-orientation\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Orientation sexuelle\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-social elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-social\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCercle d\u2019amies et vie sociale\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[social]\" id=\"form-field-social\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Combien d\u2019amies et fr\u00e9quences des visites\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-couple elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-couple\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRelation de couple\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[couple]\" id=\"form-field-couple\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Harmonieuse, distante ou conflictuelle?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-vie_intime elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-vie_intime\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQualit\u00e9 de la vie intime et sexuelle \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[vie_intime]\" id=\"form-field-vie_intime\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Bonne ou insatisfaisante?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-famille elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-famille\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact avec la famille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[famille]\" id=\"form-field-famille\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Fr\u00e9quence\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1ebe7ab elementor-col-100\">\n\t\t\t\t\t<h5 style=\"color:#F58981; text-align:center\">Hygi\u00e8ne de vie <\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sport elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sport\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tExercice\/sports\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sport]\" id=\"form-field-sport\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Lesquels et fr\u00e9quences par semaine\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-alimentation elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alimentation\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlimentation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[alimentation]\" id=\"form-field-alimentation\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Manges-tu de fa\u00e7on \u00e9quilibr\u00e9e et 3 repas par jour?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-prob_alim elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-prob_alim\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProbl\u00e9matique alimentaire\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[prob_alim]\" id=\"form-field-prob_alim\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Si oui, laquelle?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-sommeil elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-sommeil\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQualit\u00e9 du sommeil\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[sommeil]\" id=\"form-field-sommeil\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Qualit\u00e9 du sommeil \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-corps elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-corps\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAimes-tu ton corps?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[corps]\" id=\"form-field-corps\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"\u00c9chelle de 1 \u00e0 10\" min=\"1\" max=\"10\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b135901 elementor-col-100\">\n\t\t\t\t\t<h5 style=\"color:#F58981; text-align:center\">D\u00e9pendances<\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-cigarettes elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cigarettes\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCigarettes\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Oui\" id=\"form-field-cigarettes-0\" name=\"form_fields[cigarettes]\"> <label for=\"form-field-cigarettes-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-cigarettes-1\" name=\"form_fields[cigarettes]\"> <label for=\"form-field-cigarettes-1\">Non<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-alcool elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alcool\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlcool\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Oui\" id=\"form-field-alcool-0\" name=\"form_fields[alcool]\"> <label for=\"form-field-alcool-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-alcool-1\" name=\"form_fields[alcool]\"> <label for=\"form-field-alcool-1\">Non<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-drogues elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-drogues\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDrogues\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Oui\" id=\"form-field-drogues-0\" name=\"form_fields[drogues]\"> <label for=\"form-field-drogues-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-drogues-1\" name=\"form_fields[drogues]\"> <label for=\"form-field-drogues-1\">Non<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-dependances elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dependances\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutres d\u00e9pendances\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[dependances]\" id=\"form-field-dependances\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Si oui, lesquelles?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c0d7e5f elementor-col-100\">\n\t\t\t\t\t<h5 style=\"color:#F58981; text-align:center\">Traumatismes<\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-harcelement elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-harcelement\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVictime d\u2019harc\u00e8lement ou agression sexuelle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[harcelement]\" id=\"form-field-harcelement\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Victime d\u2019harc\u00e8lement ou agression sexuelle\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-pensees elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-pensees\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPens\u00e9es suicidaires\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[pensees]\" id=\"form-field-pensees\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Si oui, donner un exemple\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-peurs elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-peurs\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPeurs\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[peurs]\" id=\"form-field-peurs\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Peurs \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-estime elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-estime\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00c9valuation de l\u2019estime de soi\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[estime]\" id=\"form-field-estime\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"\u00c9chelle de 1 \u00e0 10\" min=\"1\" max=\"10\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-autres elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-autres\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutres\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[autres]\" id=\"form-field-autres\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Autres\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-page4 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Page 4\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_391cfac elementor-col-100\">\n\t\t\t\t\t<h4 style=\"text-align:center;\">Y a-t-il autre chose que tu aimerais que je sache? <\/h4>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-sache elementor-col-100\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[sache]\" id=\"form-field-sache\" rows=\"4\" placeholder=\"Y a-t-il autre chose que tu aimerais que je sache? \"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ef81640 elementor-col-75\">\n\t\t\t\t\t<p style=\"font-style: italic;\">Dans certains cas, il se pourrait que je ne puisse pas amorcer un travail de psychoth\u00e9rapie avec toi. Si \u00e7a arrive, je ferai de mon mieux pour te r\u00e9f\u00e9rer \u00e0 une professionnelle qui saura r\u00e9pondre \u00e0 tes besoins et tes objectifs.<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-annulation elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[annulation]\" id=\"form-field-annulation\" class=\"elementor-field elementor-size-lg  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-annulation\">Je comprends et j\u2019accepte <a href=\"\/faq\/\" target=\"_blank\">la politique d\u2019annulation.<\/a> <\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-retard elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[retard]\" id=\"form-field-retard\" class=\"elementor-field elementor-size-lg  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-retard\">Je comprends et j\u2019accepte <a href=\"\/faq\/\" target=\"_blank\">la politique de retard.<\/a> <\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-telepratique elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[telepratique]\" id=\"form-field-telepratique\" class=\"elementor-field elementor-size-lg  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-telepratique\">Je comprends et j\u2019accepte la t\u00e9l\u00e9pratique et je suis responsable pour ma part de la confidentialit\u00e9 (effacer les donn\u00e9es, mettre des \u00e9couteurs, choisir un endroit tranquille). <\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-limites elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[limites]\" id=\"form-field-limites\" class=\"elementor-field elementor-size-lg  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-limites\">Je comprends et j\u2019accepte les limites de la psychoth\u00e9rapie existentielle-humaniste, c\u2019est-\u00e0-dire que Dr Veltman pourra me r\u00e9f\u00e9rer en cas d\u2019urgence ou \u00e0 une autre professionnelle s\u2019il est jug\u00e9 n\u00e9cessaire.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-consentement elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[consentement]\" id=\"form-field-consentement\" class=\"elementor-field elementor-size-lg  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-consentement\">Je donne mon consentement libre et \u00e9clair\u00e9 pour entamer un processus th\u00e9rapeutique avec Dr Veltman. Je peux \u00e0 tout moment r\u00e9voquer mon consentement et demander la terminaison.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-md\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Formulaire pr\u00e9-rencontre Merci de remplir ce formulaire avant notre premi\u00e8re rencontre. Je pourrai aller plus vite dans l\u2019\u00e9valuation de tes besoins et cr\u00e9er un service personnalis\u00e9.&nbsp;&nbsp; Tu auras acc\u00e8s \u00e0 mon calendrier pour prendre un premier rendez-vous.&nbsp;&nbsp; Toutes les r\u00e9ponses dans ce formulaire sont strictement confidentielles. Je suis la seule personne qui aura acc\u00e8s \u00e0 [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":1562,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Formulaire pr\u00e9-rencontre - Dr. Heather Veltman<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/heatherveltman.com\/formulaire-pre-rencontre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire pr\u00e9-rencontre - Dr. Heather Veltman\" \/>\n<meta property=\"og:description\" content=\"Formulaire pr\u00e9-rencontre Merci de remplir ce formulaire avant notre premi\u00e8re rencontre. Je pourrai aller plus vite dans l\u2019\u00e9valuation de tes besoins et cr\u00e9er un service personnalis\u00e9.&nbsp;&nbsp; Tu auras acc\u00e8s \u00e0 mon calendrier pour prendre un premier rendez-vous.&nbsp;&nbsp; Toutes les r\u00e9ponses dans ce formulaire sont strictement confidentielles. 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Je pourrai aller plus vite dans l\u2019\u00e9valuation de tes besoins et cr\u00e9er un service personnalis\u00e9.&nbsp;&nbsp; Tu auras acc\u00e8s \u00e0 mon calendrier pour prendre un premier rendez-vous.&nbsp;&nbsp; Toutes les r\u00e9ponses dans ce formulaire sont strictement confidentielles. 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