{"meta":{"createdOn":"2026-07-10 14:03:02"},"locations":[{"id":"N1GQ","name":"Espace Sourire Chomedey","latitude":45.5467546,"longitude":-73.7755317,"geo":[45.5467546,-73.7755317],"google_place_id":"ChIJgSYXZm0jyUwRmucr7oPG1GQ","line1":"4670 Blvd. Saint-Martin O","line2":"","full_address":"4670 Blvd. Saint-Martin O  Laval Canada H7T 2Y2","postal_code":"H7T 2Y2","locality":"Laval","province":"Quebec","country":"Canada","phone":"(450) 688-0800","website_url":"\/site\/contact\/dentiste-laval-chomedey","shop_url":"","schedule":{"monday":{"start":"07:30","end":"20:00"},"tuesday":{"start":"09:00","end":"17:00"},"wednesday":{"start":"08:00","end":"17:00"},"thursday":{"start":"09:00","end":"20:00"},"friday":{"start":"09:00","end":"14:00"},"saturday":{"start":"00:00","end":"00:00"},"sunday":{"start":"00:00","end":"00:00"}},"isOpen":false,"customFields":{"Link to Google Maps":"https:\/\/maps.app.goo.gl\/7a3Vdj5shXak6cWF8","Location":"Chomedey","Multi Location Main Image":"\/files\/home-main-chomeday.jpg","Multi Location Featured Services":"<h2>Nos services dentaires<\/h2>\r\n<p class=\"leadin\">Nous offrons des soins dentaires complets pour toute la famille, allant des services d\u2019hygi\u00e8ne pr\u00e9ventive et d\u2019Invisalign aux traitements dentaires esth\u00e9tiques et \u00e0 la chirurgie buccale.<\/p>\r\n<ul class=\"list-buttons\">\r\n<li><a href=\"\/site\/prevention-hygiene-dentaire-laval\" class=\"cms-button-success\" title=\"Hygi\u00e8ne dentaire \u00e0 Espaces Sourires\">Hygi\u00e8ne dentaire<\/a><\/li>\r\n<li><a href=\"\/site\/traitement-invisalign-laval\" class=\"cms-button-success\" title=\"Traitement Invisalign \u00e0 Espaces Sourires\">Traitement Invisalign<\/a><\/li>\r\n<li><a href=\"\/site\/chirurgie-dentaire-laval\" class=\"cms-button-success\" title=\"Chirurgie dentaire \u00e0 Espaces Sourires\">Chirurgie dentaire<\/a><\/li>\r\n<li><a href=\"\/site\/services-dentisterie-esthetique-laval\" class=\"cms-button-success\" title=\"Dentisterie esth\u00e9tique \u00e0 Espaces Sourires\">Dentisterie esth\u00e9tique<\/a><\/li>\r\n<li><a href=\"\/site\/soins-dentaires-enfants-laval\" class=\"cms-button-success\" title=\"Services pour enfants \u00e0 Espaces Sourires\">Services pour enfants<\/a><\/li>\r\n<li><a href=\"\/site\/orthodontie-laval\" class=\"cms-button-success\" title=\"Orthodontie \u00e0 Espaces Sourires\">Orthodontie<\/a><\/li>\r\n<\/ul>\r\n<details>\r\n<summary>D\u00e9couvrir nos services<\/summary>\r\n<div class=\"details__content\">\r\n<ul class=\"list-buttons\">\r\n<li><a href=\"\/site\/appareils-dentaires-laval\" class=\"cms-button-success\" title=\"Appareils dentaires \u00e0 Espaces Sourires\">Appareils dentaires<\/a><\/li>\r\n<li><a href=\"\/site\/blanchiment-dents-laval\" class=\"cms-button-success\" title=\"Blanchiment des dents \u00e0 Espaces Sourires\">Blanchiment des dents<\/a><\/li>\r\n<li><a href=\"\/site\/sedation-dentaire-laval\" class=\"cms-button-success\" title=\"S\u00e9dation dentaire \u00e0 Espaces Sourires\">S\u00e9dation dentaire<\/a><\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details>","Multi Location Form Smartcode":"<div class="form-vertical">
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</script>

  
  
  
  
  
                
    
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-0">
    <label class="col-md-2  control-label " for="ifg-formfield-974-0" id="ifg-formfield-974-label-0">
      Prénom :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Prénom :" type="text"  name="ifg-formfield-974-0" id="ifg-formfield-974-0" class="element_style_0  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-974-0" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
                          
              
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-1">
    <label class="col-md-2  control-label " for="ifg-formfield-974-1" id="ifg-formfield-974-label-1">
      Nom :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Nom :" type="text"  name="ifg-formfield-974-1" id="ifg-formfield-974-1" class="element_style_1  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-974-1" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
                          
                                            <div class="form-group ifg-sort" id="ifg-element-div-2">
    <label class="col-md-2  control-label " for="ifg-formfield-974-2" id="ifg-formfield-974-label-2">
      Courriel :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Courriel :" type="email"  name="ifg-formfield-974-2" id="ifg-formfield-974-2" class="element_style_2  form-control" required aria-required="true" data-cy="email"/>
      <span for="ifg-formfield-974-2" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
                          
              
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-6">
    <label class="col-md-2  control-label " for="ifg-formfield-974-6" id="ifg-formfield-974-label-6">
      Téléphone :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Téléphone :" type="text"  name="ifg-formfield-974-6" id="ifg-formfield-974-6" class="element_style_6  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-974-6" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    
                      
              
                              <div class="form-group ifg-sort" role="group" aria-labelledby="ifg-formfield-974-label-7" id="ifg-element-div-7">
    <label class="col-md-2 control-label " id="ifg-formfield-974-label-7" role="presentation">
    Êtes-vous un nouveau patient?            <span aria-hidden="true">*</span>
        </label>
    <div class="col-md-10">
                                                    <div class="" >
            <label for="ifg-formfield-974-7-0" class="element_style_7  ">
            <input type="radio" name="ifg-formfield-974-7" id="ifg-formfield-974-7-0" class="" value="0"  required aria-required="true" data-cy="radio"/>
            Oui, je suis un nouveau patient</label>
          </div>
                                                <div class="" >
            <label for="ifg-formfield-974-7-1" class="element_style_7  ">
            <input type="radio" name="ifg-formfield-974-7" id="ifg-formfield-974-7-1" class="" value="1"   data-cy="radio"/>
            Non, je suis déjà un patient</label>
          </div>
                                                <div class="" id="ifg-formfield-974-7">
            <label for="ifg-formfield-974-7-2" class="element_style_7  ">
            <input type="radio" name="ifg-formfield-974-7" id="ifg-formfield-974-7-2" class="" value="2"   data-cy="radio"/>
             Autre</label>
          </div>
                              <span for="ifg-formfield-974-7" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
    
                      
              
                          
  
  <div class="form-group ifg-sort" id="ifg-element-div-3">
    <label class="col-md-2  control-label " for="ifg-formfield-974-3" id="ifg-formfield-974-label-3">
      Message :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <textarea  name="ifg-formfield-974-3" id="ifg-formfield-974-3" class="element_style_3  form-control" required aria-required="true" data-cy="textarea"></textarea>
      <span for="ifg-formfield-974-3" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
          
        
        
  <div class="form-group ifg-sort" id="ifg-element-div-4">
    <label class="col-md-2 control-label " for="ifg-formfield-974-4" id="ifg-formfield-974-label-4">
    Bloqueur de spam         </label>
    <div class="col-md-10">
      <div id="recaptcha-4" class="captcha-recaptcha">
        <div class="show-captcha" ></div>
      </div>
      <span for="captchaSolution" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
    <div class="form-group">
    <div id="ifg-paragraph-8" class="paragraph-layout paragraph_style_8">
    En soumettant ce formulaire, vous confirmez avoir lu et accepté la <a href="/site/politique-confidentialite" title="Politique confidentialité" target="_blank">politique de confidentialité</a> de la clinique.<br />
     </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
      <div id="f1_upload_process-974" class="form-group" style="display:none;">
    <img src="/assets/images/manage/forms/loader.svg" width="32" alt="loader" />
  </div>
  <div class="form-group">
    <input type="submit" name="ifg-formfield-974-5" id="ifg-formfield-974-5" value="Soumettre" class="form-control element_style_5 event-submit-btn-974" onclick="submitClicked(974);return false;" data-cy="form-submit"/>
  </div>
  
  
  
  
  
  
  
<input type="hidden" name="form_id" value="41606" />
<input type="hidden" name="genRand_id" value="974" />
</form>



</div>
</div>

<script type="text/javascript">
  
  var ifgSubmitURL = "/cmsi-data/formdata";
  var ifgFileAttachEnabled_974 = false;
  
    jQuery().ready(function() {

      startUpload = function(generateRand2) {
        window.globalVar2 = generateRand2;
        document.getElementById('f1_upload_form-' + globalVar2).style.visibility = 'hidden';
        return true;
      }

      stopUpload = function(response) {
        if (response.success == true) {
          if (response.file_names) {
            jQuery.each(response.file_names, function(index, element) {
              jQuery("#ifg-formfield-" + globalVar + "-" + index).val(element);
            });
          }
          ajaxSubmit();
        } else {
          jQuery(".event-err").remove();
          jQuery.each(response.err, function(index, element) {
            jQuery("#ifg-formfield-" + globalVar + "-" + element.fileindex).after(element.err);
          });
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
        }
        return true;
      }

      ajaxSubmitWithFiles = function () {
        const ifgFileAttachEnabled = window["ifgFileAttachEnabled_" + globalVar];
        const ifgFileUploadMaxFilesize = 15 * 1024 * 1024;

        fillPhoneFieldsFull(globalVar);

        // Build FormData and collect files
        const frmData = new FormData(document.getElementById("ifgForm-" + globalVar));
        const oversizedFiles = [];
        let totalFileSize = 0;

        jQuery("#upload_form-" + globalVar + " input[type='file']").each(function () {
          if (this.files && this.files.length > 0) {
            const file = this.files[0];
            const fileIndex = jQuery(this).attr("id").split("-file-").pop();

            totalFileSize += file.size;

            if (ifgFileUploadMaxFilesize > 0 && totalFileSize > ifgFileUploadMaxFilesize) {
              oversizedFiles.push(
                file.name + ' (' + (totalFileSize / 1024 / 1024).toFixed(2) + 'MB exceeds ' +
                (ifgFileUploadMaxFilesize / 1024 / 1024).toFixed(2) + 'MB limit)'
              );
              return;
            }

            const fieldKey = "ifg-formfield-" + globalVar + "-" + fileIndex + "_direct";
            frmData.append(fieldKey, file);
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        // Total size check
        if (ifgFileAttachEnabled && ifgFileUploadMaxFilesize > 0 && totalFileSize > ifgFileUploadMaxFilesize) {
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
          jQuery(".event-err").remove();
          jQuery("#ifgForm-" + globalVar).before(
            '<div class="has-error event-err"><span class="help-block-bg" style="color:#b94a48;">' +
            'Total upload size ' + (totalFileSize / 1024 / 1024).toFixed(2) + ' MB exceeds the ' +
            (ifgFileUploadMaxFilesize / 1024 / 1024).toFixed(2) + ' MB limit.' +
            '</span></div>'
          );
          jQuery("html, body").animate({ scrollTop: jQuery(".event-err").offset().top }, 500);
          return;
        }

        if (oversizedFiles.length > 0) {
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
          jQuery(".event-err").remove();
          jQuery("#ifgForm-" + globalVar).before(
            '<div class="has-error event-err"><span class="help-block-bg" style="color:#b94a48;">File too large: ' + oversizedFiles.join(', ') + '</span></div>'
          );
          jQuery("html, body").animate({ scrollTop: jQuery(".event-err").offset().top }, 500);
          return;
        }

        jQuery.ajax({
          url: ifgSubmitURL,
          data: frmData,
          type: "POST",
          async: true,
          dataType: "json",
          contentType: false,
          processData: false,
          success: function (response) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
            ifgSuccessCallback(response);
          },
          error: function (xhr, err) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
          }
        });
      };

      jQuery("#ifgForm-974").validate({
        rules: { "ifg-formfield-974-0":"required","ifg-formfield-974-1":"required","ifg-formfield-974-2":{required: true, email: true},"ifg-formfield-974-6":"required","ifg-formfield-974-7":"required","ifg-formfield-974-3":"required","captchaSolution":"required" },
        messages: { "ifg-formfield-974-0": "Champ requis","ifg-formfield-974-1": "Champ requis","ifg-formfield-974-2": "Veuillez fournir une adresse courriel valide.","ifg-formfield-974-6": "Champ requis","ifg-formfield-974-7": "Please select an option above.","ifg-formfield-974-3": "Champ requis","captchaSolution": "This field is required" },
        errorElement: 'span',
        errorPlacement: function(error, element) {
          error.insertAfter(element.closest('.col-md-10'));
        },
        errorClass: 'help-block',
        focusInvalid: true,
        ignore: "",
        invalidHandler: function(event, validator) {},
        highlight: function(element) {
          var form_id = jQuery(element).closest('form').attr('id');
          var splitFormID = form_id.split("-");
          var getFormID = splitFormID[1];
          jQuery(element).closest('.form-group').addClass('has-error');
          jQuery(element).closest('.form-group').find('.help-block').addClass('help-block-bg');
          jQuery("#f1_upload_process-" + getFormID).hide();
          jQuery(".event-submit-btn-" + getFormID).show();
        },
        unhighlight: function(element) {
          jQuery(element).closest('.form-group').removeClass('has-error');
          jQuery(element).closest('.form-group').find('.help-block').removeClass('help-block-bg');
        },
        success: function(label) {
          label.closest('.form-group').removeClass('has-error');
        },
        submitHandler: function(form) {
          var ifgFileAttachEnabled = window['ifgFileAttachEnabled_' + globalVar];

          var has_selected_file;
          jQuery('#upload_form-974').filter(function() {
            has_selected_file = true;
          }).length > 0;

          if (has_selected_file) {
            if (ifgFileAttachEnabled) {
              ajaxSubmitWithFiles();
            } else {
              jQuery("#upload_form-974").submit();
            }
          } else {
            ajaxSubmit();
          }
        }
      });

      jQuery.validator.addMethod(
        "ifgMaxFileSize",
        function (value, element, maxBytes) {
          if (!element.files || element.files.length === 0) {
            return true;
          }
          return element.files[0].size <= maxBytes;
        },
        "File too large (max {0} MB)"
      );

      submitClicked = function(generateRand) {
        window.globalVar = generateRand;
        jQuery("#f1_upload_process-" + globalVar).show();
        jQuery("#f1_upload_process-" + globalVar + " img").css({
          'border': '1px dotted rgb(204, 204, 204)',
          'border-radius': '17px',
          'background-color': '#ccc'
        });
        jQuery(".event-submit-btn-" + generateRand).hide();
        jQuery(".event-err").hide();
        jQuery(".alert").remove();
        jQuery("#ifgForm-" + generateRand).submit();
      }

      selectUploadFile = function(generateRand, counter) {
        jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).click();
      }

      showFileNameSelected = function(generateRand, counter) {
        jQuery("#ifg-upload-" + generateRand + "-file-" + counter).html(
          jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).val().split('\\').pop()
        );
        jQuery("#ifg-formfield-" + generateRand + "-" + counter).val(
          jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).val().split('\\').pop()
        );
      }

      fillPhoneFieldsFull = function(globalVar) {
        for (const phoneObj of window['phoneObjects' + globalVar]) {
          document.getElementsByName(phoneObj.phoneFieldFullName)[0].value = phoneObj.intlTelInput.getNumber();
        }
      }

            ajaxSubmit = function() {
        fillPhoneFieldsFull(globalVar);
        var frmData = jQuery("#ifgForm-" + globalVar).serialize();
        jQuery.ajax({
          url: "/cmsi-data/formdata",
          data: frmData,
          type: "POST",
          async: false,
          dataType: "json",
          success: function(response) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
            ifgSuccessCallback(response);
          },
          error: function(xhr, err) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
          }
        });
      }
      
      ifgSuccessCallback = function(response) {
                if (response.field_success == true) {
          var all_success = response.success;
          var displayAlert = true;
          if (typeof response.success_email != 'undefined' && response.success_email == true) {
            jQuery("#ifg-form-container").prepend(response.success_email_msg);
          } else if (typeof response.success_email != 'undefined' && response.success_email == false) {
            jQuery("#ifg-form-container").prepend(response.err_email_msg);
            all_success = false;
          }

          if (typeof response.success_action != 'undefined') {
            if (response.success_action == 'url-redirection' && typeof response.success_msg != 'undefined') {
              if (response.success_target == 'true') {

                jQuery("#ifgForm-"+globalVar).css("display","none");
                jQuery(".event-submit-btn-"+globalVar).css("display","none");
                jQuery("#ifgForm-"+globalVar).before("<div class='alert alert-success'>Sent.</div>");
                jQuery('html, body').animate({
                  scrollTop: jQuery(".alert").offset().top
                }, 500);
                window.open(response.success_msg, '_blank');
              } else {
                displayAlert = false;
                window.location.href = response.success_msg;
              }
            } else if (response.success_action == 'custom-msg' && typeof response.success_msg != 'undefined') {
              jQuery("#ifgForm-"+globalVar).before(response.success_msg);
            }
          }

          if ( displayAlert ){
            jQuery('html, body').animate({
              scrollTop: jQuery(".alert").offset().top
            }, 500);
          }

          jQuery("#ifgForm-"+globalVar).css("display","none");
          jQuery(".event-submit-btn-"+globalVar).css("display","none");
        } else {
          jQuery.each(response.field_err, function (index, element) {
            if ($("#" + element.field_name).closest("form").find("div.show-captcha").length > 0) {
              let recaptchaWidgetId = $("#" + element.field_name).closest("form").find("div.show-captcha").data().recaptchaWidget;
              if (typeof recaptchaWidgetId != 'undefined') {
                grecaptcha.reset(recaptchaWidgetId)
              }
            }
            jQuery("#" + element.field_name).after('<div class="has-error-' + globalVar + ' event-err"><span class="help-block-bg" style="color:#b94a48;">' + element.err + '</span></div>');
          });
        }
      }

    });
    

</script>","<div class="form-vertical">
<div class="ifg-preview-continer" id="ifg-form-container">
<form method="post" id="ifgForm-858" onsubmit="return false;" data-cy="form">

<script>
  
  if (typeof window.phoneObjects858 === 'undefined') {
    window.phoneObjects858 = [];
  }
  
</script>

  
  
  
  
  
                
    
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-0">
    <label class="col-md-2  control-label " for="ifg-formfield-858-0" id="ifg-formfield-858-label-0">
      Prénom :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Prénom :" type="text"  name="ifg-formfield-858-0" id="ifg-formfield-858-0" class="element_style_0  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-858-0" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
                          
              
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-1">
    <label class="col-md-2  control-label " for="ifg-formfield-858-1" id="ifg-formfield-858-label-1">
      Nom :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Nom :" type="text"  name="ifg-formfield-858-1" id="ifg-formfield-858-1" class="element_style_1  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-858-1" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
                          
                                            <div class="form-group ifg-sort" id="ifg-element-div-2">
    <label class="col-md-2  control-label " for="ifg-formfield-858-2" id="ifg-formfield-858-label-2">
      Courriel :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Courriel :" type="email"  name="ifg-formfield-858-2" id="ifg-formfield-858-2" class="element_style_2  form-control" required aria-required="true" data-cy="email"/>
      <span for="ifg-formfield-858-2" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
                          
              
                  
    
        <div class="form-group ifg-sort" id="ifg-element-div-6">
    <label class="col-md-2  control-label " for="ifg-formfield-858-6" id="ifg-formfield-858-label-6">
      Téléphone :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <input data-field-name="Téléphone :" type="text"  name="ifg-formfield-858-6" id="ifg-formfield-858-6" class="element_style_6  form-control" required aria-required="true" data-cy="text"/>
      <span for="ifg-formfield-858-6" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    
                      
              
                              <div class="form-group ifg-sort" role="group" aria-labelledby="ifg-formfield-858-label-8" id="ifg-element-div-8">
    <label class="col-md-2 control-label " id="ifg-formfield-858-label-8" role="presentation">
    Êtes-vous un nouveau patient?            <span aria-hidden="true">*</span>
        </label>
    <div class="col-md-10">
                                                    <div class="" >
            <label for="ifg-formfield-858-8-0" class="element_style_8  ">
            <input type="radio" name="ifg-formfield-858-8" id="ifg-formfield-858-8-0" class="" value="0"  required aria-required="true" data-cy="radio"/>
            Oui, je suis un nouveau patient</label>
          </div>
                                                <div class="" >
            <label for="ifg-formfield-858-8-1" class="element_style_8  ">
            <input type="radio" name="ifg-formfield-858-8" id="ifg-formfield-858-8-1" class="" value="1"   data-cy="radio"/>
            Non, je suis déjà un patient</label>
          </div>
                                                <div class="" id="ifg-formfield-858-8">
            <label for="ifg-formfield-858-8-2" class="element_style_8  ">
            <input type="radio" name="ifg-formfield-858-8" id="ifg-formfield-858-8-2" class="" value="2"   data-cy="radio"/>
            Autre</label>
          </div>
                              <span for="ifg-formfield-858-8" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
    
                      
              
                          
  
  <div class="form-group ifg-sort" id="ifg-element-div-3">
    <label class="col-md-2  control-label " for="ifg-formfield-858-3" id="ifg-formfield-858-label-3">
      Message :              <span aria-hidden="true">*</span>
      
    </label>
    <div class="col-md-10">
      <textarea  name="ifg-formfield-858-3" id="ifg-formfield-858-3" class="element_style_3  form-control" required aria-required="true" data-cy="textarea"></textarea>
      <span for="ifg-formfield-858-3" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
          
        
        
  <div class="form-group ifg-sort" id="ifg-element-div-4">
    <label class="col-md-2 control-label " for="ifg-formfield-858-4" id="ifg-formfield-858-label-4">
    Bloqueur de spam         </label>
    <div class="col-md-10">
      <div id="recaptcha-4" class="captcha-recaptcha">
        <div class="show-captcha" ></div>
      </div>
      <span for="captchaSolution" class="help-block"></span>
          </div>
  </div>
  
  
  
  
  
  
  
  
  
  
    <div class="form-group">
    <div id="ifg-paragraph-7" class="paragraph-layout paragraph_style_7">
    En soumettant ce formulaire, vous confirmez avoir lu et accepté la <a href="/site/politique-confidentialite" title="Politique confidentialité" target="_blank">politique de confidentialité</a> de la clinique.     </div>
  </div>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
      <div id="f1_upload_process-858" class="form-group" style="display:none;">
    <img src="/assets/images/manage/forms/loader.svg" width="32" alt="loader" />
  </div>
  <div class="form-group">
    <input type="submit" name="ifg-formfield-858-5" id="ifg-formfield-858-5" value="Soumettre" class="form-control element_style_5 event-submit-btn-858" onclick="submitClicked(858);return false;" data-cy="form-submit"/>
  </div>
  
  
  
  
  
  
  
<input type="hidden" name="form_id" value="41543" />
<input type="hidden" name="genRand_id" value="858" />
</form>



</div>
</div>

<script type="text/javascript">
  
  var ifgSubmitURL = "/cmsi-data/formdata";
  var ifgFileAttachEnabled_858 = false;
  
    jQuery().ready(function() {

      startUpload = function(generateRand2) {
        window.globalVar2 = generateRand2;
        document.getElementById('f1_upload_form-' + globalVar2).style.visibility = 'hidden';
        return true;
      }

      stopUpload = function(response) {
        if (response.success == true) {
          if (response.file_names) {
            jQuery.each(response.file_names, function(index, element) {
              jQuery("#ifg-formfield-" + globalVar + "-" + index).val(element);
            });
          }
          ajaxSubmit();
        } else {
          jQuery(".event-err").remove();
          jQuery.each(response.err, function(index, element) {
            jQuery("#ifg-formfield-" + globalVar + "-" + element.fileindex).after(element.err);
          });
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
        }
        return true;
      }

      ajaxSubmitWithFiles = function () {
        const ifgFileAttachEnabled = window["ifgFileAttachEnabled_" + globalVar];
        const ifgFileUploadMaxFilesize = 15 * 1024 * 1024;

        fillPhoneFieldsFull(globalVar);

        // Build FormData and collect files
        const frmData = new FormData(document.getElementById("ifgForm-" + globalVar));
        const oversizedFiles = [];
        let totalFileSize = 0;

        jQuery("#upload_form-" + globalVar + " input[type='file']").each(function () {
          if (this.files && this.files.length > 0) {
            const file = this.files[0];
            const fileIndex = jQuery(this).attr("id").split("-file-").pop();

            totalFileSize += file.size;

            if (ifgFileUploadMaxFilesize > 0 && totalFileSize > ifgFileUploadMaxFilesize) {
              oversizedFiles.push(
                file.name + ' (' + (totalFileSize / 1024 / 1024).toFixed(2) + 'MB exceeds ' +
                (ifgFileUploadMaxFilesize / 1024 / 1024).toFixed(2) + 'MB limit)'
              );
              return;
            }

            const fieldKey = "ifg-formfield-" + globalVar + "-" + fileIndex + "_direct";
            frmData.append(fieldKey, file);
          }
        });

        // Total size check
        if (ifgFileAttachEnabled && ifgFileUploadMaxFilesize > 0 && totalFileSize > ifgFileUploadMaxFilesize) {
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
          jQuery(".event-err").remove();
          jQuery("#ifgForm-" + globalVar).before(
            '<div class="has-error event-err"><span class="help-block-bg" style="color:#b94a48;">' +
            'Total upload size ' + (totalFileSize / 1024 / 1024).toFixed(2) + ' MB exceeds the ' +
            (ifgFileUploadMaxFilesize / 1024 / 1024).toFixed(2) + ' MB limit.' +
            '</span></div>'
          );
          jQuery("html, body").animate({ scrollTop: jQuery(".event-err").offset().top }, 500);
          return;
        }

        if (oversizedFiles.length > 0) {
          jQuery("#f1_upload_process-" + globalVar).hide();
          jQuery(".event-submit-btn-" + globalVar).show();
          jQuery(".event-err").remove();
          jQuery("#ifgForm-" + globalVar).before(
            '<div class="has-error event-err"><span class="help-block-bg" style="color:#b94a48;">File too large: ' + oversizedFiles.join(', ') + '</span></div>'
          );
          jQuery("html, body").animate({ scrollTop: jQuery(".event-err").offset().top }, 500);
          return;
        }

        jQuery.ajax({
          url: ifgSubmitURL,
          data: frmData,
          type: "POST",
          async: true,
          dataType: "json",
          contentType: false,
          processData: false,
          success: function (response) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
            ifgSuccessCallback(response);
          },
          error: function (xhr, err) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
          }
        });
      };

      jQuery("#ifgForm-858").validate({
        rules: { "ifg-formfield-858-0":"required","ifg-formfield-858-1":"required","ifg-formfield-858-2":{required: true, email: true},"ifg-formfield-858-6":"required","ifg-formfield-858-8":"required","ifg-formfield-858-3":"required","captchaSolution":"required" },
        messages: { "ifg-formfield-858-0": "Champ requis","ifg-formfield-858-1": "Champ requis","ifg-formfield-858-2": "Veuillez fournir une adresse courriel valide.","ifg-formfield-858-6": "Champ requis","ifg-formfield-858-8": "Please select an option above.","ifg-formfield-858-3": "Champ requis","captchaSolution": "This field is required" },
        errorElement: 'span',
        errorPlacement: function(error, element) {
          error.insertAfter(element.closest('.col-md-10'));
        },
        errorClass: 'help-block',
        focusInvalid: true,
        ignore: "",
        invalidHandler: function(event, validator) {},
        highlight: function(element) {
          var form_id = jQuery(element).closest('form').attr('id');
          var splitFormID = form_id.split("-");
          var getFormID = splitFormID[1];
          jQuery(element).closest('.form-group').addClass('has-error');
          jQuery(element).closest('.form-group').find('.help-block').addClass('help-block-bg');
          jQuery("#f1_upload_process-" + getFormID).hide();
          jQuery(".event-submit-btn-" + getFormID).show();
        },
        unhighlight: function(element) {
          jQuery(element).closest('.form-group').removeClass('has-error');
          jQuery(element).closest('.form-group').find('.help-block').removeClass('help-block-bg');
        },
        success: function(label) {
          label.closest('.form-group').removeClass('has-error');
        },
        submitHandler: function(form) {
          var ifgFileAttachEnabled = window['ifgFileAttachEnabled_' + globalVar];

          var has_selected_file;
          jQuery('#upload_form-858').filter(function() {
            has_selected_file = true;
          }).length > 0;

          if (has_selected_file) {
            if (ifgFileAttachEnabled) {
              ajaxSubmitWithFiles();
            } else {
              jQuery("#upload_form-858").submit();
            }
          } else {
            ajaxSubmit();
          }
        }
      });

      jQuery.validator.addMethod(
        "ifgMaxFileSize",
        function (value, element, maxBytes) {
          if (!element.files || element.files.length === 0) {
            return true;
          }
          return element.files[0].size <= maxBytes;
        },
        "File too large (max {0} MB)"
      );

      submitClicked = function(generateRand) {
        window.globalVar = generateRand;
        jQuery("#f1_upload_process-" + globalVar).show();
        jQuery("#f1_upload_process-" + globalVar + " img").css({
          'border': '1px dotted rgb(204, 204, 204)',
          'border-radius': '17px',
          'background-color': '#ccc'
        });
        jQuery(".event-submit-btn-" + generateRand).hide();
        jQuery(".event-err").hide();
        jQuery(".alert").remove();
        jQuery("#ifgForm-" + generateRand).submit();
      }

      selectUploadFile = function(generateRand, counter) {
        jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).click();
      }

      showFileNameSelected = function(generateRand, counter) {
        jQuery("#ifg-upload-" + generateRand + "-file-" + counter).html(
          jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).val().split('\\').pop()
        );
        jQuery("#ifg-formfield-" + generateRand + "-" + counter).val(
          jQuery("#ifg-formfield-" + generateRand + "-file-" + counter).val().split('\\').pop()
        );
      }

      fillPhoneFieldsFull = function(globalVar) {
        for (const phoneObj of window['phoneObjects' + globalVar]) {
          document.getElementsByName(phoneObj.phoneFieldFullName)[0].value = phoneObj.intlTelInput.getNumber();
        }
      }

            ajaxSubmit = function() {
        fillPhoneFieldsFull(globalVar);
        var frmData = jQuery("#ifgForm-" + globalVar).serialize();
        jQuery.ajax({
          url: "/cmsi-data/formdata",
          data: frmData,
          type: "POST",
          async: false,
          dataType: "json",
          success: function(response) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
            ifgSuccessCallback(response);
          },
          error: function(xhr, err) {
            jQuery("#f1_upload_process-" + globalVar).hide();
            jQuery(".event-submit-btn-" + globalVar).show();
          }
        });
      }
      
      ifgSuccessCallback = function(response) {
                if (response.field_success == true) {
          var all_success = response.success;
          var displayAlert = true;
          if (typeof response.success_email != 'undefined' && response.success_email == true) {
            jQuery("#ifg-form-container").prepend(response.success_email_msg);
          } else if (typeof response.success_email != 'undefined' && response.success_email == false) {
            jQuery("#ifg-form-container").prepend(response.err_email_msg);
            all_success = false;
          }

          if (typeof response.success_action != 'undefined') {
            if (response.success_action == 'url-redirection' && typeof response.success_msg != 'undefined') {
              if (response.success_target == 'true') {

                jQuery("#ifgForm-"+globalVar).css("display","none");
                jQuery(".event-submit-btn-"+globalVar).css("display","none");
                jQuery("#ifgForm-"+globalVar).before("<div class='alert alert-success'>Sent.</div>");
                jQuery('html, body').animate({
                  scrollTop: jQuery(".alert").offset().top
                }, 500);
                window.open(response.success_msg, '_blank');
              } else {
                displayAlert = false;
                window.location.href = response.success_msg;
              }
            } else if (response.success_action == 'custom-msg' && typeof response.success_msg != 'undefined') {
              jQuery("#ifgForm-"+globalVar).before(response.success_msg);
            }
          }

          if ( displayAlert ){
            jQuery('html, body').animate({
              scrollTop: jQuery(".alert").offset().top
            }, 500);
          }

          jQuery("#ifgForm-"+globalVar).css("display","none");
          jQuery(".event-submit-btn-"+globalVar).css("display","none");
        } else {
          jQuery.each(response.field_err, function (index, element) {
            if ($("#" + element.field_name).closest("form").find("div.show-captcha").length > 0) {
              let recaptchaWidgetId = $("#" + element.field_name).closest("form").find("div.show-captcha").data().recaptchaWidget;
              if (typeof recaptchaWidgetId != 'undefined') {
                grecaptcha.reset(recaptchaWidgetId)
              }
            }
            jQuery("#" + element.field_name).after('<div class="has-error-' + globalVar + ' event-err"><span class="help-block-bg" style="color:#b94a48;">' + element.err + '</span></div>');
          });
        }
      }

    });
    

</script>"],"Practice Description":[""],"Practice NAP":[""]}}