{"id":4725,"date":"2023-02-06T14:19:39","date_gmt":"2023-02-06T19:19:39","guid":{"rendered":"https:\/\/nblimmigration.com\/?page_id=4725"},"modified":"2023-04-28T09:29:43","modified_gmt":"2023-04-28T14:29:43","slug":"formulaire","status":"publish","type":"page","link":"https:\/\/nblimmigration.com\/fr\/formulaire\/","title":{"rendered":"Formulaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4725\" class=\"elementor elementor-4725\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d652158 e-con-full e-flex e-con e-parent\" data-id=\"d652158\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-78e1a7c elementor-widget elementor-widget-heading\" data-id=\"78e1a7c\" 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<h2 class=\"elementor-heading-title elementor-size-default\">Demande de rendez-vous pour une consultation initiale<\/h2>\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-c65317a e-con-full e-flex e-con e-parent\" data-id=\"c65317a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-baf34d1 e-con-full e-flex e-con e-parent\" data-id=\"baf34d1\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f07fe22 elementor-widget elementor-widget-heading\" data-id=\"f07fe22\" 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<h2 class=\"elementor-heading-title 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inherit; font-weight: 600; text-transform: inherit; font-style: inherit; text-decoration: inherit; line-height: 1.2; letter-spacing: 0px; font-size: 20px;} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row.jet-form-builder-row.jet-form-builder-row.jet-form-builder-row{margin: -28px 0px 0px 10px;text-align: left;} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar-date .jet-apb-calendar-date-body{color: var(--theme-palette-color-4, #102136);} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar-date.jet-apb-calendar-date--disabled .jet-apb-calendar-date-body{color: var(--theme-palette-color-4, #102136) !important;} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar-date:hover .jet-apb-calendar-date-body{color: var(--theme-palette-color-2, #8c0026);} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar-date--selected .jet-apb-calendar-date-body{color: var(--theme-palette-color-4, #102136);} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar-date--today .jet-apb-calendar-date-body{color: var(--theme-palette-color-5, #E7EBEE);} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder__label span.jet-form-builder__required.jet-form-builder__required.jet-form-builder__required{color: var(--theme-palette-color-2, #8c0026);} .jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6 .jet-form-builder-row .jet-apb-calendar .jet-apb-calendar-content{width: 50%;min-width: {{SIZE}}%;flex: 0 0 {{SIZE}}%;} .jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e .jet-form-builder__desc.jet-form-builder__desc.jet-form-builder__desc{background-color: ;margin: 0px 0px 0px 12px;} .jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e .jet-form-builder__field-wrap input{border-style:none;border-width:1px 1px 1px 1px;border-radius:1px 1px 1px 1px;border-color:#000000;} .jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e .jet-form-builder-row.jet-form-builder-row.jet-form-builder-row.jet-form-builder-row{margin: 30px 0px 0px 0px;text-align: left;} .jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e .jet-form-builder__label.jet-form-builder__label.jet-form-builder__label{margin: 0px 0px 0px 12px;} .jet-sm-gb-397e292d-614d-4f15-b70f-a684740169c9 .jet-form-builder__desc.jet-form-builder__desc.jet-form-builder__desc{background-color: ;margin: 0px 0px 0px 12px;} .jet-sm-gb-397e292d-614d-4f15-b70f-a684740169c9 .jet-form-builder-row.jet-form-builder-row.jet-form-builder-row.jet-form-builder-row{margin: 0px 0px 0px 0px;} .jet-sm-gb-397e292d-614d-4f15-b70f-a684740169c9 .jet-form-builder__label.jet-form-builder__label.jet-form-builder__label{margin: 0px 0px 0px 12px;} <\/style><form  class=\"jet-form-builder layout-column submit-type-ajax\" action=\"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages\/4725\/?Ppj5se=AtyHzv7J2M&amp;method=reload\" method=\"POST\" data-form-id=\"4773\" data-layout=\"column\" enctype=\"multipart\/form-data\" novalidate=\"null\" ssr_validation_method=\"rest\">\r\n<input type=\"hidden\" name=\"_jfb_current_render_states[]\" value=\"DEFAULT.STATE\" data-jfb-sync \/><input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_booking_form_id\" data-field-name=\"_jet_engine_booking_form_id\" value=\"4773\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_refer\" data-field-name=\"_jet_engine_refer\" value=\"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages\/4725\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"4725\">\n\n<h3 class=\"wp-block-heading\" style=\"margin-top:0;margin-right:0;margin-bottom:var(--wp--preset--spacing--60);margin-left:0;font-size:clamp(16.834px, 1.052rem + ((1vw - 3.2px) * 0.716), 26px);\">Remplissez en indiquant vos informations personnelles<\/h3>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Nom<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-05c827ce-2936-4ff5-857d-6ef740dc8224\" data-block-id=\"jet-sm-gb-05c827ce-2936-4ff5-857d-6ef740dc8224\" ><div  data-validation-type=\"advanced\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"nom\" id=\"nom\" type=\"text\" data-field-name=\"nom\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_FWknsRgT\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-text-align-left has-palette-color-4-color has-text-color\">Pr\u00e9nom<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-281c064d-d86e-4410-a8d9-deda67e7b613\" data-block-id=\"jet-sm-gb-281c064d-d86e-4410-a8d9-deda67e7b613\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"prenom\" id=\"prenom\" type=\"text\" data-field-name=\"prenom\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_bJD2NEOw\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-text-align-left has-palette-color-4-color has-text-color\">Date de naissance<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-8eadef68-fa96-4fcc-9f03-1221f0b1c6ac\" data-block-id=\"jet-sm-gb-8eadef68-fa96-4fcc-9f03-1221f0b1c6ac\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-date-field\" >\n<input class=\"jet-form-builder__field date-field\" required=\"required\" name=\"date_de_naissance\" type=\"date\" data-field-name=\"date_de_naissance\" id=\"date_de_naissance\" data-jfb-sync=\"null\">\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Citoyennet\u00e9<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-add81b78-0d44-4d86-b061-9de4eadc3c5a\" data-block-id=\"jet-sm-gb-add81b78-0d44-4d86-b061-9de4eadc3c5a\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"citoyennete\" id=\"citoyennete\" type=\"text\" data-field-name=\"citoyennete\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_PKEqCvwL\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-text-align-left has-palette-color-4-color has-text-color\">Profession \/ Occupation<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-820a43bf-0e46-446e-b27b-08fc2cdf8dbb\" data-block-id=\"jet-sm-gb-820a43bf-0e46-446e-b27b-08fc2cdf8dbb\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"profession__occupation\" id=\"profession__occupation\" type=\"text\" data-field-name=\"profession__occupation\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_YzDxmF3p\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-text-align-left has-palette-color-4-color has-text-color\">\u00c9tat matrimonial<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-c2fb92d4-00af-4076-8171-7feed9dc5bbf\" data-block-id=\"jet-sm-gb-c2fb92d4-00af-4076-8171-7feed9dc5bbf\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"etat_matrimonial\" id=\"etat_matrimonial\" type=\"text\" data-field-name=\"etat_matrimonial\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_yO2eEYHj\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-b2d68e09-0c24-4005-b2de-f0a28029bfad\" data-block-id=\"jet-sm-gb-b2d68e09-0c24-4005-b2de-f0a28029bfad\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Langues parl\u00e9es <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"langues_parlees[]\" value=\"francais\" data-field-name=\"langues_parlees\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\"><span>Fran\u00e7ais<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"langues_parlees[]\" value=\"anglais\" data-field-name=\"langues_parlees\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\"><span>Anglais<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"langues_parlees[]\" value=\"autre_langue\" data-field-name=\"langues_parlees\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\"><span>Autre<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-6d6feee6-6318-4d51-8594-b8427943da7f\" data-block-id=\"jet-sm-gb-6d6feee6-6318-4d51-8594-b8427943da7f\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;one_of&quot;,&quot;value&quot;:&quot;autre_langue&quot;,&quot;field&quot;:&quot;langues_parlees&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-f16e81fe-877e-4f8c-aac5-5d89290573d2\" data-block-id=\"jet-sm-gb-f16e81fe-877e-4f8c-aac5-5d89290573d2\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">P\u00e9cisez la langue <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"pecisez_la_langue\" id=\"pecisez_la_langue\" type=\"text\" data-field-name=\"pecisez_la_langue\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_kzCrEmPu\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/div>\n<\/div>\n\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Num\u00e9ro de t\u00e9l\u00e9phone<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-22a47658-4001-452a-ac32-de247afcb492\" data-block-id=\"jet-sm-gb-22a47658-4001-452a-ac32-de247afcb492\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"numero_de_telephone\" id=\"numero_de_telephone\" type=\"tel\" data-field-name=\"numero_de_telephone\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_HBk2V983\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Adresse email<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-886128bd-25e7-45f7-b0f4-0de114696374\" data-block-id=\"jet-sm-gb-886128bd-25e7-45f7-b0f4-0de114696374\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"adresse_email\" id=\"adresse_email\" type=\"email\" data-field-name=\"adresse_email\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_5JLTO9dt\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns alignfull is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-constrained wp-block-column-is-layout-constrained\" style=\"flex-basis:100%\">\n<p class=\"has-palette-color-3-color has-text-color\" style=\"font-size:clamp(14px, 0.875rem + ((1vw - 3.2px) * 0.391), 19px);\"><strong>Pays o\u00f9 la personne concern\u00e9e est actuellement et\/ou pr\u00e9voit d'\u00eatre au moment du rendez-vous<\/strong><sup>*<\/sup>:<\/p>\n\n\n\n<p style=\"font-size:11px\">Note: Si vous s\u00e9lectionnez ''Canada'' assurez vous d'avoir indiqu\u00e9 un num\u00e9ro canadien valide.<\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-aebee2b2-9a76-4411-97ab-7470e6144616\" data-block-id=\"jet-sm-gb-aebee2b2-9a76-4411-97ab-7470e6144616\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"pays_actuel\" value=\"canada\" data-field-name=\"pays_actuel\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Canada<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"pays_actuel\" value=\"autre_pays\" data-field-name=\"pays_actuel\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Autre<\/span><\/label><\/div><\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f9de769a-85eb-4414-9df7-2446b1310b78\" data-block-id=\"jet-sm-gb-f9de769a-85eb-4414-9df7-2446b1310b78\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;one_of&quot;,&quot;value&quot;:&quot;canada&quot;,&quot;field&quot;:&quot;pays_actuel&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<p class=\"has-palette-color-4-color has-text-color\">Adresse postal<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" data-block-id=\"jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"adesse\" id=\"adesse\" type=\"text\" data-field-name=\"adesse\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_wKnXc46y\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Ville<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" data-block-id=\"jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"ville\" id=\"ville\" type=\"text\" data-field-name=\"ville\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_h4WXHije\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Province<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" data-block-id=\"jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"field_name\" data-field-name=\"field_name\" id=\"field_name\" data-jfb-sync=\"null\">\n\t\t<option value=\"quebec\" >Qu\u00e9bec<\/option><option value=\"alberta\" >Alberta<\/option><option value=\"ile-du-prince-edouard\" >\u00cele du Prince-\u00c9douard<\/option><option value=\"Nouveau-Brunswick\" >Nouveau-Brunswick<\/option><option value=\"nouvelle-ecosse\" >Nouvelle-\u00c9cosse<\/option><option value=\"nunavut\" >Nunavut<\/option><option value=\"ontario\" >Ontario<\/option><option value=\"saskatchewan\" >Saskatchewan<\/option><option value=\"Terre-Neuve-et-Labrador\" >Terre-Neuve-et-Labrador<\/option><option value=\"Territoire-du-nord-ouest\" >Territoire du Nord-Ouest<\/option><option value=\"yukon\" >Yukon<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Code postal<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" data-block-id=\"jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"code_postal\" id=\"code_postal\" type=\"text\" data-field-name=\"code_postal\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_k7D5GlsV\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/div>\n<\/div>\n\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f9de769a-85eb-4414-9df7-2446b1310b78\" data-block-id=\"jet-sm-gb-f9de769a-85eb-4414-9df7-2446b1310b78\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;one_of&quot;,&quot;value&quot;:&quot;autre_pays&quot;,&quot;field&quot;:&quot;pays_actuel&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<p class=\"has-palette-color-4-color has-text-color\">Adresse postal<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" data-block-id=\"jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"adesse\" id=\"adesse_1\" type=\"text\" data-field-name=\"adesse\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_6yg4a10X\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Ville<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" data-block-id=\"jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"ville\" id=\"ville_1\" type=\"text\" data-field-name=\"ville\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_uXNf35jk\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\"> \u00c9tat \/ Province \/ R\u00e9gion<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6f87bc1f-53f4-4f57-b591-1a97723e82e8\" data-block-id=\"jet-sm-gb-6f87bc1f-53f4-4f57-b591-1a97723e82e8\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"province\" id=\"province\" type=\"text\" data-field-name=\"province\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Lk9AstGV\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">ZIP \/ Code postal<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" data-block-id=\"jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"code_postal\" id=\"code_postal_1\" type=\"text\" data-field-name=\"code_postal\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_2yVp5ATI\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Paye<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" data-block-id=\"jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"pays\" id=\"pays\" type=\"text\" data-field-name=\"pays\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_qArjzPX7\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-7c6b5526-8921-4110-b2db-7e92bb85418e\" data-block-id=\"jet-sm-gb-7c6b5526-8921-4110-b2db-7e92bb85418e\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"mandataire\" value=\"mandataire\" data-field-name=\"mandataire\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\"><span>Cochez cette case si vous prenez le rendez-vous pour un ami ou un membre de votre famille et remplissez avec les informations personnelles de la personne<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-fbd7d255-b229-42f7-a697-83a8ba53324e\" data-block-id=\"jet-sm-gb-fbd7d255-b229-42f7-a697-83a8ba53324e\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;not_empty&quot;,&quot;value&quot;:&quot;mandataire&quot;,&quot;field&quot;:&quot;mandataire&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Nom<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-05c827ce-2936-4ff5-857d-6ef740dc8224\" data-block-id=\"jet-sm-gb-05c827ce-2936-4ff5-857d-6ef740dc8224\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"nom_mandataire\" id=\"nom_mandataire\" type=\"text\" data-field-name=\"nom_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Zmj90hWr\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Pr\u00e9nom<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-281c064d-d86e-4410-a8d9-deda67e7b613\" data-block-id=\"jet-sm-gb-281c064d-d86e-4410-a8d9-deda67e7b613\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"prenom_mandataire\" id=\"prenom_mandataire\" type=\"text\" data-field-name=\"prenom_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_ocREiN1a\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Date de naissance<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-8eadef68-fa96-4fcc-9f03-1221f0b1c6ac\" data-block-id=\"jet-sm-gb-8eadef68-fa96-4fcc-9f03-1221f0b1c6ac\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-date-field\" >\n<input class=\"jet-form-builder__field date-field\" required=\"required\" name=\"date_de_naissance_mandataire\" type=\"date\" data-field-name=\"date_de_naissance_mandataire\" id=\"date_de_naissance_mandataire\" data-jfb-sync=\"null\">\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-bottom is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Citoyennet\u00e9<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-add81b78-0d44-4d86-b061-9de4eadc3c5a\" data-block-id=\"jet-sm-gb-add81b78-0d44-4d86-b061-9de4eadc3c5a\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"citoyennete_mandataire\" id=\"citoyennete_mandataire\" type=\"text\" data-field-name=\"citoyennete_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_6jtOHrC2\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Profession \/ occupation<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-820a43bf-0e46-446e-b27b-08fc2cdf8dbb\" data-block-id=\"jet-sm-gb-820a43bf-0e46-446e-b27b-08fc2cdf8dbb\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"profession__occupation_mandataire\" id=\"profession__occupation_mandataire\" type=\"text\" data-field-name=\"profession__occupation_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_dwCASr7D\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">\u00c9tat matrimonial du mandataire<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-c2fb92d4-00af-4076-8171-7feed9dc5bbf\" data-block-id=\"jet-sm-gb-c2fb92d4-00af-4076-8171-7feed9dc5bbf\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"etat_matrimonial\" id=\"etat_matrimonial_1\" type=\"text\" data-field-name=\"etat_matrimonial\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_0tY5mB82\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-bottom is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Num\u00e9ro de t\u00e9l\u00e9phone<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-22a47658-4001-452a-ac32-de247afcb492\" data-block-id=\"jet-sm-gb-22a47658-4001-452a-ac32-de247afcb492\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"numero_de_telephone_mandataire\" id=\"numero_de_telephone_mandataire\" type=\"tel\" data-field-name=\"numero_de_telephone_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_mciyOPUo\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Adresse email<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-886128bd-25e7-45f7-b0f4-0de114696374\" data-block-id=\"jet-sm-gb-886128bd-25e7-45f7-b0f4-0de114696374\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"adresse_email_mandataire\" id=\"adresse_email_mandataire\" type=\"email\" data-field-name=\"adresse_email_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_jFSQZwPk\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Adresse postal<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" data-block-id=\"jet-sm-gb-96f577a3-fc3e-47bb-a23d-a204987e4dcd\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"adesse_mandataire\" id=\"adesse_mandataire\" type=\"text\" data-field-name=\"adesse_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_UqzWKdhM\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Ville<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" data-block-id=\"jet-sm-gb-f6e42a79-95b4-47f9-9436-6beacee87027\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"ville_mandataire\" id=\"ville_mandataire\" type=\"text\" data-field-name=\"ville_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_GPs01dxF\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">\u00c9tat \/ Province \/ R\u00e9gion<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6f87bc1f-53f4-4f57-b591-1a97723e82e8\" data-block-id=\"jet-sm-gb-6f87bc1f-53f4-4f57-b591-1a97723e82e8\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"province\" id=\"province_1\" type=\"text\" data-field-name=\"province\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_A6lYHt4b\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">ZIP \/ Code postal<\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" data-block-id=\"jet-sm-gb-e39e02c6-dd11-4d0c-9e4a-f83f74e24e95\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"code_postal_mandataire\" id=\"code_postal_mandataire\" type=\"text\" data-field-name=\"code_postal_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_mJfT927x\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p class=\"has-palette-color-4-color has-text-color\">Pays<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" data-block-id=\"jet-sm-gb-f90f83fe-a342-408f-868d-fa9f8b960b0f\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"pays_mandataire\" id=\"pays_mandataire\" type=\"text\" data-field-name=\"pays_mandataire\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Ek8UfOA2\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n<\/div><\/div>\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e\" data-block-id=\"jet-sm-gb-e0283a4d-0ca9-4eac-914f-22181d03ba2e\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Service<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"service_id\" data-field-name=\"service_id\" id=\"service_id\" data-jfb-sync=\"null\">\n\t\t<option value=\"4849\" >Consultation initiale<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\"><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-397e292d-614d-4f15-b70f-a684740169c9\" data-block-id=\"jet-sm-gb-397e292d-614d-4f15-b70f-a684740169c9\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Consultant<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"fournisseur_id\" data-field-name=\"fournisseur_id\" id=\"fournisseur_id\" data-jfb-sync=\"null\">\n\t\t<option value=\"5520\" >Blaise N.<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\"><\/div>\n<\/div>\n\n\n\n<p class=\"has-palette-color-4-color has-text-color\" style=\"font-size:clamp(14px, 0.875rem + ((1vw - 3.2px) * 0.313), 18px);\">Choisir la date de votre consultation<sup>*<\/sup><\/p>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6\" data-block-id=\"jet-sm-gb-5498a25a-3c9a-41d8-a02b-3e97d36116d6\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-appointment-date\" >\n<div class=\"jet-apb-calendar-wrapper\">\n\t<div class=\"appointment-calendar jet-apb-calendar\" data-args=\"{&quot;booking_type&quot;:&quot;slot&quot;,&quot;excludedDates&quot;:[{&quot;start&quot;:1672531200,&quot;end&quot;:1672531200}],&quot;datesMode&quot;:&quot;override_full&quot;,&quot;worksDates&quot;:[],&quot;datesRange&quot;:{&quot;start&quot;:0,&quot;end&quot;:0},&quot;availableWeekDays&quot;:[&quot;saturday&quot;],&quot;service&quot;:{&quot;field&quot;:&quot;service_id&quot;},&quot;providerIsset&quot;:true,&quot;provider&quot;:{&quot;field&quot;:&quot;fournisseur_id&quot;},&quot;inputName&quot;:&quot;rendez-vous&quot;,&quot;isRequired&quot;:true,&quot;allowedServices&quot;:{&quot;field&quot;:&quot;fournisseur_id&quot;},&quot;slotAutoCheck&quot;:false}\"><\/div>\n\n\t\t<div class=\"jet-apb-calendar-appointments-list-wrapper\" style=\"display: none\">\n\t\t<div class=\"jet-form-builder__heading\">\n\t\t\t<span class=\"jet-form-builder__label-text\">Appointment details:<\/span>\n\t\t<\/div>\n\t\t<div class=\"jet-apb-calendar-appointments-list\"><\/div>\n\t<\/div>\n\t<div class=\"jet-apb-calendar-notification\" style=\"display: none\">\n\t\t<div class=\"jet-apb-calendar-notification-service\">Please, select the service first.<\/div>\n\t\t<div class=\"jet-apb-calendar-notification-provider\">Please, select the provider first.<\/div>\n\t\t<div class=\"jet-apb-calendar-notification-service-field\">Please set service field for current calendar<\/div>\n\t\t<div class=\"jet-apb-calendar-notification-max-slots\">Sorry. You have the max number of appointments.<\/div>\n\t<\/div>\n<\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-c8362efc-569e-4f89-ae54-cfcc2a0e9c63\" data-block-id=\"jet-sm-gb-c8362efc-569e-4f89-ae54-cfcc2a0e9c63\" ><div  data-validation-type=\"inherit\" class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"submit\" class=\"jet-form-builder__action-button-wrapper jet-form-builder__submit-wrap\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__submit submit-type-ajax\" type=\"submit\">Envoyer<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\t<div class=\"jet-form-builder-messages-wrap\" data-form-id=\"4773\"><\/div>\n<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\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>Demande de rendez-vous pour une consultation initiale Formulaire Remplissez en indiquant vos informations personnelles Nom* Pr\u00e9nom* Date de naissance* Citoyennet\u00e9* Profession \/ Occupation* \u00c9tat matrimonial* Langues parl\u00e9es * Fran\u00e7ais Anglais Autre P\u00e9cisez la langue * Num\u00e9ro de t\u00e9l\u00e9phone* Adresse email* Pays o\u00f9 la personne concern\u00e9e est actuellement et\/ou pr\u00e9voit d&rsquo;\u00eatre au moment du rendez-vous*: Note: [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_jf_save_progress":"","_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"class_list":["post-4725","page","type-page","status-publish","hentry"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"_links":{"self":[{"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages\/4725","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/comments?post=4725"}],"version-history":[{"count":376,"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages\/4725\/revisions"}],"predecessor-version":[{"id":5704,"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/pages\/4725\/revisions\/5704"}],"wp:attachment":[{"href":"https:\/\/nblimmigration.com\/fr\/wp-json\/wp\/v2\/media?parent=4725"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}