{"id":413,"date":"2022-10-14T16:14:12","date_gmt":"2022-10-14T20:14:12","guid":{"rendered":"https:\/\/www.srfhosp.ca\/compliments-complaints-form\/"},"modified":"2023-01-16T10:03:36","modified_gmt":"2023-01-16T15:03:36","slug":"compliments-complaints-form","status":"publish","type":"page","link":"https:\/\/www.srfhosp.ca\/fr\/compliments-complaints-form\/","title":{"rendered":"Formulaire de Compliments\/Plaintes"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block\" id=\"wpforms-454\"><form id=\"wpforms-form-454\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"454\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/413\" data-token=\"97dc3911011b28501113dfbbb35c3f64\" data-token-time=\"1777660243\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-454-field_1-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Je Suis: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-454-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-454-field_1_1\" name=\"wpforms[fields][1]\" value=\"Un(e) patient(e)\/client(e)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-454-field_1_1\">Un(e) patient(e)\/client(e)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-454-field_1_2\" name=\"wpforms[fields][1]\" value=\"Un membre de la famille d&#039;un(e) patient(e)\/ami(e) d&#039;un(e) client(e)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-454-field_1_2\">Un membre de la famille d&rsquo;un(e) patient(e)\/ami(e) d&rsquo;un(e) client(e)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-454-field_1_3\" name=\"wpforms[fields][1]\" value=\"Un visiteur(se) \/ membre du public\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-454-field_1_3\">Un visiteur(se) \/ membre du public<\/label><\/li><\/ul><\/div><div id=\"wpforms-454-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_3\">Nom et Pr\u00e9nom: <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-454-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" placeholder=\"Pr\u00e9nom\" required><label for=\"wpforms-454-field_3\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-454-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" placeholder=\"Nom de Famille\" required><label for=\"wpforms-454-field_3-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-454-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_4\">Rue:  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-454-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-454-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_5\">Unit\u00e9\/App.:<\/label><input type=\"text\" id=\"wpforms-454-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" ><\/div><div id=\"wpforms-454-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_6\">Case Postale:<\/label><input type=\"text\" id=\"wpforms-454-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-454-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_7\">Ville: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-454-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-454-field_8-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_8\">Province:  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-454-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>(S\u00e9lectionnez-en une)<\/option><option value=\"Alberta\"  class=\"choice-1 depth-1\"  >Alberta<\/option><option value=\"British Columbia\"  class=\"choice-2 depth-1\"  >British Columbia<\/option><option value=\"Manitoba\"  class=\"choice-3 depth-1\"  >Manitoba<\/option><option value=\"New Brunswick\"  class=\"choice-13 depth-1\"  >New Brunswick<\/option><option value=\"Newfoundland and Labrador\"  class=\"choice-12 depth-1\"  >Newfoundland and Labrador<\/option><option value=\"Northwest Territories\"  class=\"choice-11 depth-1\"  >Northwest Territories<\/option><option value=\"Nova Scotia\"  class=\"choice-10 depth-1\"  >Nova Scotia<\/option><option value=\"Nunavut\"  class=\"choice-9 depth-1\"  >Nunavut<\/option><option value=\"Ontario\"  class=\"choice-8 depth-1\"  >Ontario<\/option><option value=\"Prince Edward Island\"  class=\"choice-7 depth-1\"  >Prince Edward Island<\/option><option value=\"Quebec\"  class=\"choice-6 depth-1\"  >Quebec<\/option><option value=\"Saskatchewan\"  class=\"choice-5 depth-1\"  >Saskatchewan<\/option><option value=\"Yukon\"  class=\"choice-4 depth-1\"  >Yukon<\/option><\/select><\/div><div id=\"wpforms-454-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_9\">Code Postal:  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-454-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-454-field_10-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_10\">Num\u00e9ro de T\u00e9l\u00e9phone: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-454-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" value=\"1-(705)-111-222\" step=\"any\" required><\/div><div id=\"wpforms-454-field_11-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_11\">Adresse Email: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-454-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-454-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-454-field_12\">Commentaires:<\/label><textarea id=\"wpforms-454-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LcjV38iAAAAAJN8h6__577AFlmw4mAHl9vLlU2z\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"454\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/pages\/413\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-454\" class=\"wpforms-submit\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.srfhosp.ca\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-413","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/pages\/413","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/comments?post=413"}],"version-history":[{"count":2,"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/pages\/413\/revisions"}],"predecessor-version":[{"id":458,"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/pages\/413\/revisions\/458"}],"wp:attachment":[{"href":"https:\/\/www.srfhosp.ca\/fr\/wp-json\/wp\/v2\/media?parent=413"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}