{"id":1859,"date":"2017-07-07T12:30:13","date_gmt":"2017-07-07T16:30:13","guid":{"rendered":"https:\/\/cliniquespectrum.com\/referral-form\/"},"modified":"2020-11-12T14:32:05","modified_gmt":"2020-11-12T19:32:05","slug":"formulaire-recommandation","status":"publish","type":"page","link":"https:\/\/cliniquespectrum.com\/fr\/formulaire-recommandation\/","title":{"rendered":"Formulaire de recommandation"},"content":{"rendered":"

[et_pb_section fb_built=\u00a0\u00bb1″ _builder_version=\u00a0\u00bb3.22″][et_pb_row _builder_version=\u00a0\u00bb3.25″ background_size=\u00a0\u00bbinitial\u00a0\u00bb background_position=\u00a0\u00bbtop_left\u00a0\u00bb background_repeat=\u00a0\u00bbrepeat\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb3.25″ custom_padding=\u00a0\u00bb|||\u00a0\u00bb custom_padding__hover=\u00a0\u00bb|||\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb3.27.4″ border_style=\u00a0\u00bbsolid\u00a0\u00bb]<\/p>\n

Formulaire de recommandation<\/h1>\n

[\/et_pb_text][et_pb_contact_form email=\u00a0\u00bbinfo@cliniquespectrum.com\u00a0\u00bb custom_message=\u00a0\u00bbReferral Form||et_pb_line_break_holder||||et_pb_line_break_holder||Date: %%Date%%||et_pb_line_break_holder||Name: %%Name%%||et_pb_line_break_holder||Email: %%Email%%||et_pb_line_break_holder||||et_pb_line_break_holder||Details:||et_pb_line_break_holder||%%Details%%||et_pb_line_break_holder||||et_pb_line_break_holder||Request:||et_pb_line_break_holder||%%Request%%||et_pb_line_break_holder||||et_pb_line_break_holder||Name of professional making the referral: %%referrerName%%||et_pb_line_break_holder||Referrer’s profession: %%referrerProfession%%||et_pb_line_break_holder||License number: %%referrerNumber%%||et_pb_line_break_holder||||et_pb_line_break_holder||\u00a0\u00bb success_message=\u00a0\u00bbMerci d’avoir soumis une recommandation, nous vous contacterons sous peu par courriel.\u00a0\u00bb submit_button_text=\u00a0\u00bbSoumettre\u00a0\u00bb admin_label=\u00a0\u00bbReferral Form\u00a0\u00bb _builder_version=\u00a0\u00bb4.6.6″ hover_enabled=\u00a0\u00bb0″ border_radii=\u00a0\u00bbon|0px|0px|0px|0px\u00a0\u00bb button_letter_spacing_hover=\u00a0\u00bb0″ sticky_enabled=\u00a0\u00bb0″][et_pb_contact_field field_id=\u00a0\u00bbDate\u00a0\u00bb field_title=\u00a0\u00bbDate\u00a0\u00bb fullwidth_field=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.11″ form_field_font=\u00a0\u00bb||||\u00a0\u00bb use_border_color=\u00a0\u00bboff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbName\u00a0\u00bb field_title=\u00a0\u00bbNom et pr\u00e9nom\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″ form_field_font=\u00a0\u00bb||||\u00a0\u00bb use_border_color=\u00a0\u00bboff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbEmail\u00a0\u00bb field_title=\u00a0\u00bbCourriel\u00a0\u00bb field_type=\u00a0\u00bbemail\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″ form_field_font=\u00a0\u00bb||||\u00a0\u00bb use_border_color=\u00a0\u00bboff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbDetails\u00a0\u00bb field_title=\u00a0\u00bbDescription\u00a0\u00bb field_type=\u00a0\u00bbtext\u00a0\u00bb fullwidth_field=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″ form_field_font=\u00a0\u00bb||||\u00a0\u00bb use_border_color=\u00a0\u00bboff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbRequest\u00a0\u00bb field_title=\u00a0\u00bbDEMANDE DE SUIVI DE LA CLINIQUE SPECTRUM (COCHEZ TOUTES LES CASES PERTINENTES) J\u2019aimerais recevoir plus d\u2019informations sur :\u00a0\u00bb field_type=\u00a0\u00bbcheckbox\u00a0\u00bb checkbox_options=\u00a0\u00bb%91{%22value%22:%22L\u2019\u00e9valuation d\u2019un(e) jeune enfant%22,%22checked%22:0,%22dragID%22:-1,%22link_url%22:%22%22,%22link_text%22:%22%22},{%22value%22:%22L\u2019\u00e9valuation en pr\u00e9vision de la transition vers l\u2019\u00e9cole primaire ou secondaire%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22L\u2019\u00e9valuation d\u2019un(e) adulte%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Les interventions pr\u00e9coces offertes \u00e0 mon enfant%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Les ateliers offerts aux parents%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Les ateliers offerts aux \u00e9ducateurs en garderie%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Les services d\u2019orthophonie%22,%22checked%22:0,%22dragID%22:5},{%22value%22:%22L\u2019\u00e9ducation en sant\u00e9 sexuelle%22,%22checked%22:0,%22dragID%22:7},{%22value%22:%22Les formations et ateliers offerts aux professionnels%22,%22checked%22:0,%22dragID%22:11}%93″ required_mark=\u00a0\u00bboff\u00a0\u00bb fullwidth_field=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb4.6.6″ form_field_font=\u00a0\u00bb||||\u00a0\u00bb hover_enabled=\u00a0\u00bb0″ use_border_color=\u00a0\u00bboff\u00a0\u00bb border_style=\u00a0\u00bbsolid\u00a0\u00bb sticky_enabled=\u00a0\u00bb0″][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbreferrerName\u00a0\u00bb field_title=\u00a0\u00bbNom du professionnel qui a fait la recommandation\u00a0\u00bb fullwidth_field=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbreferrerProfession\u00a0\u00bb field_title=\u00a0\u00bbProfession du r\u00e9f\u00e9rent\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″][\/et_pb_contact_field][et_pb_contact_field field_id=\u00a0\u00bbreferrerNumber\u00a0\u00bb field_title=\u00a0\u00bbNum\u00e9ro de licence\u00a0\u00bb _builder_version=\u00a0\u00bb3.19.13″][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

Formulaire de recommandation<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1859","page","type-page","status-publish","hentry"],"yoast_head":"\nReferral Form | Clinique Spectrum<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cliniquespectrum.com\/referral-form\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Referral Form | Clinique Spectrum\" \/>\n<meta property=\"og:description\" content=\"Formulaire de recommandation\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cliniquespectrum.com\/referral-form\/\" \/>\n<meta property=\"og:site_name\" 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