{"id":8210,"date":"2024-10-05T08:01:54","date_gmt":"2024-10-05T06:01:54","guid":{"rendered":"https:\/\/kenya4u.com\/?page_id=8210"},"modified":"2024-10-07T00:02:11","modified_gmt":"2024-10-06T22:02:11","slug":"formulaire-medical-trip-package","status":"publish","type":"page","link":"https:\/\/kenya4u.com\/en\/formulaire-medical-trip-package\/","title":{"rendered":"Formulaire Medical Trip Package"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8210\" class=\"elementor elementor-8210\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-18bd855 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"18bd855\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-c63df51\" data-id=\"c63df51\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-afb2bee elementor-widget elementor-widget-heading\" data-id=\"afb2bee\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Formulaire de r\u00e9servation<\/h1>\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<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-36fa551 elementor-hidden-mobile e-flex e-con-boxed e-con e-parent\" data-id=\"36fa551\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-2510862 e-con-full e-flex e-con e-child\" data-id=\"2510862\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a351836 e-con-full e-flex e-con e-child\" data-id=\"a351836\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4044292 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"4044292\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Formulaire Medical Trip pc\" aria-label=\"Formulaire Medical Trip pc\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8210\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"4044292\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Formulaire Medical Trip Package - KENYA 4 You\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"8210\"\/>\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-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" 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[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_b150c30 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b150c30\" 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[field_b150c30]\" id=\"form-field-field_b150c30\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_77f5e04 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_77f5e04\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPays de r\u00e9sidence\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[field_77f5e04]\" id=\"form-field-field_77f5e04\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_ec3cb65 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ec3cb65\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVille\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[field_ec3cb65]\" id=\"form-field-field_ec3cb65\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-email elementor-field-group elementor-column elementor-field-group-field_8b447ad elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8b447ad\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\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[field_8b447ad]\" id=\"form-field-field_8b447ad\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_ed6c86d elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed6c86d\" 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[field_ed6c86d]\" id=\"form-field-field_ed6c86d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" 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-select elementor-field-group elementor-column elementor-field-group-field_62bd4ab elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_62bd4ab\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLangue de pr\u00e9f\u00e9rence pour les \u00e9changes\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<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_62bd4ab]\" id=\"form-field-field_62bd4ab\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Autre\">Autre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Anglais\">Anglais<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fran\u00e7ais\" selected=\"selected\">Fran\u00e7ais<\/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-date elementor-field-group elementor-column elementor-field-group-field_cac1e6f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cac1e6f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate d'arriv\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_cac1e6f]\" id=\"form-field-field_cac1e6f\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_d81c21c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d81c21c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate de d\u00e9part\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_d81c21c]\" id=\"form-field-field_d81c21c\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\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-field_60c81ac elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_60c81ac\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRaison principale du s\u00e9jour m\u00e9dical \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[field_60c81ac]\" id=\"form-field-field_60c81ac\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"(exemple : consultation sp\u00e9cialis\u00e9e, chirurgie, suivi m\u00e9dical)\" required=\"required\">\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-radio elementor-field-group elementor-column elementor-field-group-field_bfaf7d8 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bfaf7d8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAnt\u00e9c\u00e9dents m\u00e9dicaux \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=\"radio\" value=\"Autorisation de partage s\u00e9curis\u00e9 avec l\u2019\u00e9quipe m\u00e9dicale\" id=\"form-field-field_bfaf7d8-0\" name=\"form_fields[field_bfaf7d8]\" required=\"required\"> <label for=\"form-field-field_bfaf7d8-0\">Autorisation de partage s\u00e9curis\u00e9 avec l\u2019\u00e9quipe m\u00e9dicale<\/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-field_976c149 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_976c149\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSouhaitez-vous un accompagnant durant votre s\u00e9jour \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-field_976c149-0\" name=\"form_fields[field_976c149]\" required=\"required\"> <label for=\"form-field-field_976c149-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_976c149-1\" name=\"form_fields[field_976c149]\" required=\"required\"> <label for=\"form-field-field_976c149-1\">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-field_b6c0a33 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b6c0a33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rences en mati\u00e8re de logement \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=\"Chambre simple\" id=\"form-field-field_b6c0a33-0\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-0\">Chambre simple<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Chambre double\" id=\"form-field-field_b6c0a33-1\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-1\">Chambre double<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"H\u00f4tel\" id=\"form-field-field_b6c0a33-2\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-2\">H\u00f4tel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Airbnb\" id=\"form-field-field_b6c0a33-3\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-3\">Airbnb<\/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-field_54e364e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_54e364e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tActivit\u00e9s post-r\u00e9tablissement <br> Souhaitez-vous profiter des visites guid\u00e9es et excursions \u00e0 Nairobi apr\u00e8s votre r\u00e9tablissement ?\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-field_54e364e-0\" name=\"form_fields[field_54e364e]\" required=\"required\"> <label for=\"form-field-field_54e364e-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_54e364e-1\" name=\"form_fields[field_54e364e]\" required=\"required\"> <label for=\"form-field-field_54e364e-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-field_669bb30 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_669bb30\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBesoin de transport ?<br> Avez-vous besoin d'une navette entre l\u2019a\u00e9roport et votre h\u00e9bergement ?\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-field_669bb30-0\" name=\"form_fields[field_669bb30]\" required=\"required\"> <label for=\"form-field-field_669bb30-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_669bb30-1\" name=\"form_fields[field_669bb30]\" required=\"required\"> <label for=\"form-field-field_669bb30-1\">Non<\/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_ed998f3 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed998f3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQuestions ou remarques suppl\u00e9mentaires<br> Champ libre pour toute question ou besoin sp\u00e9cifique\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ed998f3]\" id=\"form-field-field_ed998f3\" rows=\"4\" required=\"required\"><\/textarea>\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-field_eb079c2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eb079c2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMode de contact pr\u00e9f\u00e9r\u00e9\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=\"Email\" id=\"form-field-field_eb079c2-0\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-0\">Email<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"T\u00e9l\u00e9phone\" id=\"form-field-field_eb079c2-1\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-1\">T\u00e9l\u00e9phone<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"WhatsApp\" id=\"form-field-field_eb079c2-2\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-2\">WhatsApp<\/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-field_67a60ac elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_67a60ac\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tM\u00e9thode de paiement pr\u00e9f\u00e9r\u00e9e\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=\"Carte bancaire\" id=\"form-field-field_67a60ac-0\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-0\">Carte bancaire<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"PayPal\" id=\"form-field-field_67a60ac-1\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-1\">PayPal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Virement bancaire\" id=\"form-field-field_67a60ac-2\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-2\">Virement bancaire<\/label><\/span><\/div>\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-field_8dc83d1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8dc83d1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tConsentement :\t\t\t\t\t\t\t<\/label>\n\t\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[field_8dc83d1]\" id=\"form-field-field_8dc83d1\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_8dc83d1\">Je consens \u00e0 ce que mes informations m\u00e9dicales soient partag\u00e9es de mani\u00e8re s\u00e9curis\u00e9e avec les professionnels de sant\u00e9 concern\u00e9s. <\/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-recaptcha elementor-field-group elementor-column elementor-field-group-field_34e3c06 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_34e3c06\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LfSnVkqAAAAALNXmZc2AWXLBT2JlM_yPD40jcOr\" data-type=\"v2_checkbox\" data-theme=\"light\" data-size=\"normal\"><\/div><\/div>\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 class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\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 ma demande<\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-99fe3c3 e-con-full e-flex e-con e-child\" data-id=\"99fe3c3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2605e5a elementor-hidden-desktop elementor-hidden-laptop elementor-hidden-tablet e-flex e-con-boxed e-con e-parent\" data-id=\"2605e5a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-85b6bac e-con-full e-flex e-con e-child\" data-id=\"85b6bac\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4eeea3d e-con-full e-flex e-con e-child\" data-id=\"4eeea3d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6c33114 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"6c33114\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Formulaire Medical Trip mobile\" aria-label=\"Formulaire Medical Trip mobile\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8210\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"6c33114\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Formulaire Medical Trip Package - KENYA 4 You\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"8210\"\/>\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-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" 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[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_b150c30 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b150c30\" 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[field_b150c30]\" id=\"form-field-field_b150c30\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_77f5e04 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_77f5e04\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPays de r\u00e9sidence\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[field_77f5e04]\" id=\"form-field-field_77f5e04\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_ec3cb65 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ec3cb65\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVille\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[field_ec3cb65]\" id=\"form-field-field_ec3cb65\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-email elementor-field-group elementor-column elementor-field-group-field_8b447ad elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8b447ad\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\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[field_8b447ad]\" id=\"form-field-field_8b447ad\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\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-field_ed6c86d elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed6c86d\" 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[field_ed6c86d]\" id=\"form-field-field_ed6c86d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" 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-select elementor-field-group elementor-column elementor-field-group-field_62bd4ab elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_62bd4ab\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLangue de pr\u00e9f\u00e9rence pour les \u00e9changes\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<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_62bd4ab]\" id=\"form-field-field_62bd4ab\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Autre\">Autre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Anglais\">Anglais<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fran\u00e7ais\" selected=\"selected\">Fran\u00e7ais<\/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-date elementor-field-group elementor-column elementor-field-group-field_cac1e6f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cac1e6f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate d'arriv\u00e9e\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_cac1e6f]\" id=\"form-field-field_cac1e6f\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_d81c21c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d81c21c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate de d\u00e9part\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_d81c21c]\" id=\"form-field-field_d81c21c\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\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-field_60c81ac elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_60c81ac\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRaison principale du s\u00e9jour m\u00e9dical \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[field_60c81ac]\" id=\"form-field-field_60c81ac\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"(exemple : consultation sp\u00e9cialis\u00e9e, chirurgie, suivi m\u00e9dical)\" required=\"required\">\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-radio elementor-field-group elementor-column elementor-field-group-field_bfaf7d8 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bfaf7d8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAnt\u00e9c\u00e9dents m\u00e9dicaux \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=\"radio\" value=\"Autorisation de partage s\u00e9curis\u00e9 avec l\u2019\u00e9quipe m\u00e9dicale\" id=\"form-field-field_bfaf7d8-0\" name=\"form_fields[field_bfaf7d8]\" required=\"required\"> <label for=\"form-field-field_bfaf7d8-0\">Autorisation de partage s\u00e9curis\u00e9 avec l\u2019\u00e9quipe m\u00e9dicale<\/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-field_976c149 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_976c149\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSouhaitez-vous un accompagnant durant votre s\u00e9jour \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-field_976c149-0\" name=\"form_fields[field_976c149]\" required=\"required\"> <label for=\"form-field-field_976c149-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_976c149-1\" name=\"form_fields[field_976c149]\" required=\"required\"> <label for=\"form-field-field_976c149-1\">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-field_b6c0a33 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b6c0a33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rences en mati\u00e8re de logement \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=\"radio\" value=\"Chambre simple\" id=\"form-field-field_b6c0a33-0\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-0\">Chambre simple<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Chambre double\" id=\"form-field-field_b6c0a33-1\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-1\">Chambre double<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"H\u00f4tel\" id=\"form-field-field_b6c0a33-2\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-2\">H\u00f4tel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Airbnb\" id=\"form-field-field_b6c0a33-3\" name=\"form_fields[field_b6c0a33]\" required=\"required\"> <label for=\"form-field-field_b6c0a33-3\">Airbnb<\/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-field_54e364e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_54e364e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tActivit\u00e9s post-r\u00e9tablissement <br> Souhaitez-vous profiter des visites guid\u00e9es et excursions \u00e0 Nairobi apr\u00e8s votre r\u00e9tablissement ?\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-field_54e364e-0\" name=\"form_fields[field_54e364e]\" required=\"required\"> <label for=\"form-field-field_54e364e-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_54e364e-1\" name=\"form_fields[field_54e364e]\" required=\"required\"> <label for=\"form-field-field_54e364e-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-field_669bb30 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_669bb30\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBesoin de transport ?<br> Avez-vous besoin d'une navette entre l\u2019a\u00e9roport et votre h\u00e9bergement ?\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-field_669bb30-0\" name=\"form_fields[field_669bb30]\" required=\"required\"> <label for=\"form-field-field_669bb30-0\">Oui<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-field_669bb30-1\" name=\"form_fields[field_669bb30]\" required=\"required\"> <label for=\"form-field-field_669bb30-1\">Non<\/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_ed998f3 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed998f3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQuestions ou remarques suppl\u00e9mentaires<br> Champ libre pour toute question ou besoin sp\u00e9cifique\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ed998f3]\" id=\"form-field-field_ed998f3\" rows=\"4\" required=\"required\"><\/textarea>\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-field_eb079c2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eb079c2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMode de contact pr\u00e9f\u00e9r\u00e9\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=\"radio\" value=\"Email\" id=\"form-field-field_eb079c2-0\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-0\">Email<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"T\u00e9l\u00e9phone\" id=\"form-field-field_eb079c2-1\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-1\">T\u00e9l\u00e9phone<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"WhatsApp\" id=\"form-field-field_eb079c2-2\" name=\"form_fields[field_eb079c2]\" required=\"required\"> <label for=\"form-field-field_eb079c2-2\">WhatsApp<\/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-field_67a60ac elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_67a60ac\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tM\u00e9thode de paiement pr\u00e9f\u00e9r\u00e9e\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=\"radio\" value=\"Carte bancaire\" id=\"form-field-field_67a60ac-0\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-0\">Carte bancaire<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"PayPal\" id=\"form-field-field_67a60ac-1\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-1\">PayPal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Virement bancaire\" id=\"form-field-field_67a60ac-2\" name=\"form_fields[field_67a60ac]\" required=\"required\"> <label for=\"form-field-field_67a60ac-2\">Virement bancaire<\/label><\/span><\/div>\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-field_8dc83d1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8dc83d1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tConsentement :\t\t\t\t\t\t\t<\/label>\n\t\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[field_8dc83d1]\" id=\"form-field-field_8dc83d1\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_8dc83d1\">Je consens \u00e0 ce que mes informations m\u00e9dicales soient partag\u00e9es de mani\u00e8re s\u00e9curis\u00e9e avec les professionnels de sant\u00e9 concern\u00e9s. <\/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-recaptcha elementor-field-group elementor-column elementor-field-group-field_34e3c06 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_34e3c06\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LfSnVkqAAAAALNXmZc2AWXLBT2JlM_yPD40jcOr\" data-type=\"v2_checkbox\" data-theme=\"light\" data-size=\"normal\"><\/div><\/div>\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 class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\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 ma demande<\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a5f7790 e-con-full e-flex e-con e-child\" data-id=\"a5f7790\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Reservation form<\/p>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-8210","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/pages\/8210","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/comments?post=8210"}],"version-history":[{"count":0,"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/pages\/8210\/revisions"}],"wp:attachment":[{"href":"https:\/\/kenya4u.com\/en\/wp-json\/wp\/v2\/media?parent=8210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}