{"id":1327,"date":"2025-12-30T16:46:34","date_gmt":"2025-12-30T16:46:34","guid":{"rendered":"https:\/\/dev.peleweb.com\/vetoheritan?page_id=1327"},"modified":"2026-05-04T11:18:04","modified_gmt":"2026-05-04T11:18:04","slug":"referer-un-patient","status":"publish","type":"page","link":"https:\/\/dev.peleweb.com\/vetoheritan\/referer-un-patient\/","title":{"rendered":"R\u00e9f\u00e9rer un patient"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#FCF6F3&Prime; hover_enabled=\u00a0\u00bb0&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime;][et_pb_row column_structure=\u00a0\u00bb2_5,3_5&Prime; module_class=\u00a0\u00bbrow&#8211;center\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb2_5&Prime; module_class=\u00a0\u00bbbutton&#8211;inline\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h1>R\u00e9f\u00e9rer<br \/>un patient<\/h1>\n<p>Vous souhaitez nous confier l\u2019un de vos patients pour un avis sp\u00e9cialis\u00e9 ?<\/p>\n<p>L\u2019\u00e9quipe de la Clinique de l\u2019H\u00e9ritan met ses comp\u00e9tences et son plateau technique \u00e0 votre disposition.<\/p>\n<p>Merci de remplir le formulaire ci-dessous.<\/p>\n<p><strong>Attention, cette page est destin\u00e9e aux professionnels v\u00e9t\u00e9rinaires.<\/strong><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=\u00a0\u00bb3_5&Prime; _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_image src=\u00a0\u00bbhttps:\/\/dev.peleweb.com\/vetoheritan\/wp-content\/uploads\/2026\/04\/Referer-un-patient.png\u00a0\u00bb alt=\u00a0\u00bbR\u00e9f\u00e9rer un patient, r\u00e9f\u00e9rer un cas v\u00e9t\u00e9rinaire\u00a0\u00bb title_text=\u00a0\u00bbReferer-un-patient\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb border_radii=\u00a0\u00bbon|20px|20px|20px|20px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row module_class=\u00a0\u00bbrow&#8211;refere\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_2_text_align=\u00a0\u00bbcenter\u00a0\u00bb text_orientation=\u00a0\u00bbcenter\u00a0\u00bb custom_margin=\u00a0\u00bb||||false|false\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h2>Formulaire de r\u00e9f\u00e9r\u00e9<\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_2_text_align=\u00a0\u00bbcenter\u00a0\u00bb text_orientation=\u00a0\u00bbcenter\u00a0\u00bb custom_margin=\u00a0\u00bb||70px||false|false\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p>Pour r\u00e9f\u00e9rer un cas v\u00e9t\u00e9rinaire en ligne, merci de compl\u00e9ter le formulaire ci-dessous.<br \/><strong>Ce formulaire doit \u00eatre compl\u00e9t\u00e9 et transmis UNIQUEMENT par le v\u00e9t\u00e9rinaire.<\/strong><br \/>Merci aux propri\u00e9taires d\u2019animaux de contacter leur v\u00e9t\u00e9rinaire en cas de besoin.<\/p>\n<p>[\/et_pb_text][et_pb_code module_class=\u00a0\u00bbrefere&#8211;form\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-1348 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1348\" data-uid=\"6a2353ac6ab1f\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-1348\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1348 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"1348\"\r\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a2353ac6ab1f\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">V\u00e9t\u00e9rinaire<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a2353ac6ab1f\" id=\"forminator-field-name-2_6a2353ac6ab1f-label\" class=\"forminator-label\">Dr. Nom \/ Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a2353ac6ab1f\" id=\"forminator-field-text-1_6a2353ac6ab1f-label\" class=\"forminator-label\">Clinique <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a2353ac6ab1f\" id=\"forminator-field-email-2_6a2353ac6ab1f-label\" class=\"forminator-label\">Adresse e-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a2353ac6ab1f\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6a2353ac6ab1f\" id=\"forminator-field-phone-2_6a2353ac6ab1f-label\" class=\"forminator-label\">T\u00e9l\u00e9phone<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_6a2353ac6ab1f\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Propri\u00e9taire<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a2353ac6ab1f\" id=\"forminator-field-name-3_6a2353ac6ab1f-label\" class=\"forminator-label\">Nom \/ Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a2353ac6ab1f\" id=\"forminator-field-text-2_6a2353ac6ab1f-label\" class=\"forminator-label\">Adresse<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-3\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_6a2353ac6ab1f\" id=\"forminator-field-email-3_6a2353ac6ab1f-label\" class=\"forminator-label\">Adresse e-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"\" id=\"forminator-field-email-3_6a2353ac6ab1f\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a2353ac6ab1f\" id=\"forminator-field-phone-3_6a2353ac6ab1f-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-3_6a2353ac6ab1f\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Animal<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6a2353ac6ab1f\" id=\"forminator-field-name-4_6a2353ac6ab1f-label\" class=\"forminator-label\">Nom<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a2353ac6ab1f\" id=\"forminator-field-text-3_6a2353ac6ab1f-label\" class=\"forminator-label\">\u00c2ge<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a2353ac6ab1f-label\"><span id=\"forminator-radiogroup-radio-1-6a2353ac6ab1f-label\" class=\"forminator-label\">Esp\u00e8ce <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Chien\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Chien<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Chat\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Chat<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Nac\"><input type=\"radio\" name=\"radio-1\" value=\"Nac\" id=\"forminator-field-radio-1-3-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nac<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_6a2353ac6ab1f\" id=\"forminator-field-name-5_6a2353ac6ab1f-label\" class=\"forminator-label\">Race<\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"\" id=\"forminator-field-name-5_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_6a2353ac6ab1f\" id=\"forminator-field-name-6_6a2353ac6ab1f-label\" class=\"forminator-label\">Poids<\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"\" id=\"forminator-field-name-6_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a2353ac6ab1f\" id=\"forminator-field-date-1-picker_6a2353ac6ab1f-label\" class=\"forminator-label\">Date de naissance<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"05\/06\/2026\" placeholder=\"Choisissez une date\" id=\"forminator-field-date-1-picker_6a2353ac6ab1f\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a2353ac6ab1f-label\"><span id=\"forminator-radiogroup-radio-2-6a2353ac6ab1f-label\" class=\"forminator-label\">Sexe <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"M\u00e2le\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">M\u00e2le<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Femelle\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Femelle<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Indetermin\u00e9\"><input type=\"radio\" name=\"radio-2\" value=\"Nac\" id=\"forminator-field-radio-2-3-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Indetermin\u00e9<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a2353ac6ab1f-label\"><span id=\"forminator-radiogroup-radio-3-6a2353ac6ab1f-label\" class=\"forminator-label\">L&#039;animal est identifi\u00e9 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a2353ac6ab1f\" id=\"forminator-field-text-4_6a2353ac6ab1f-label\" class=\"forminator-label\">Si oui, merci de pr\u00e9ciser le num\u00e9ro de puce \u00e9lectronique<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a2353ac6ab1f\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a2353ac6ab1f-label\"><span id=\"forminator-radiogroup-radio-4-6a2353ac6ab1f-label\" class=\"forminator-label\">L&#039;animal est assur\u00e9 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a2353ac6ab1f-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a2353ac6ab1f-label\" class=\"forminator-label\">L&#039;animal est<\/span><label id=\"forminator-field-checkbox-1-1-6a2353ac6ab1f-label\" for=\"forminator-field-checkbox-1-1-6a2353ac6ab1f\" class=\"forminator-checkbox\" title=\"St\u00e9rilis\u00e9\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-checkbox-1-1-6a2353ac6ab1f-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">St\u00e9rilis\u00e9<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a2353ac6ab1f-label\" for=\"forminator-field-checkbox-1-2-6a2353ac6ab1f\" class=\"forminator-checkbox\" title=\"Vaccin\u00e9\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-checkbox-1-2-6a2353ac6ab1f-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Vaccin\u00e9<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Prise en charge<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a2353ac6ab1f-label\"><span id=\"forminator-radiogroup-radio-6-6a2353ac6ab1f-label\" class=\"forminator-label\">Niveau de prise en charge souhait\u00e9 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Prise en charge globale : consultation, diagnostic, traitement m\u00e9dical\/chirurgical\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Prise en charge globale : consultation, diagnostic, traitement m\u00e9dical\/chirurgical<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a2353ac6ab1f\" class=\"forminator-radio\" title=\"Etablissement du diagnostic seul : consultation, examens compl\u00e9mentaires\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6a2353ac6ab1f\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Etablissement du diagnostic seul : consultation, examens compl\u00e9mentaires<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Renseignements cliniques<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a2353ac6ab1f\" id=\"forminator-field-textarea-2_6a2353ac6ab1f-label\" class=\"forminator-label\">Motif de r\u00e9f\u00e9r\u00e9 <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a2353ac6ab1f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:90px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1348__field--select-1_6a2353ac6ab1f\" id=\"forminator-form-1348__field--select-1_6a2353ac6ab1f-label\" class=\"forminator-label\">Service concern\u00e9 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1348__field--select-1_6a2353ac6ab1f\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"M\u00e9decine pr\u00e9ventive\" data-hidden-behavior=\"zero\" data-placeholder=\"Merci de choisir une option\" data-search=\"false\" data-search-placeholder=\"Merci de choisir une option\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1348__field--select-1_6a2353ac6ab1f-label\"><option value=\"\"  >Merci de choisir une option<\/option><option value=\"M\u00e9decine pr\u00e9ventive\" selected=\"selected\" data-calculation=\"0\">M\u00e9decine pr\u00e9ventive<\/option><option value=\"Chirurgie -  Orthop\u00e9die\"  data-calculation=\"0\">Chirurgie -  Orthop\u00e9die<\/option><option value=\"M\u00e9decine g\u00e9n\u00e9rale et interne\"  data-calculation=\"0\">M\u00e9decine g\u00e9n\u00e9rale et interne<\/option><option value=\"Dermatologie\"  data-calculation=\"0\">Dermatologie<\/option><option value=\"Imagerie m\u00e9dicale\"  data-calculation=\"0\">Imagerie m\u00e9dicale<\/option><option value=\"Hospitalisation\"  data-calculation=\"0\">Hospitalisation<\/option><option value=\"NAC\"  data-calculation=\"0\">NAC<\/option><option value=\"Nutrition\"  data-calculation=\"0\">Nutrition<\/option><option value=\"Cytologie\"  data-calculation=\"0\">Cytologie<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a2353ac6ab1f\" id=\"forminator-field-textarea-1_6a2353ac6ab1f-label\" class=\"forminator-label\">Historique et traitements ant\u00e9rieurs <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a2353ac6ab1f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:155px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a2353ac6ab1f\" id=\"forminator-field-upload-1_6a2353ac6ab1f-label\" class=\"forminator-label\">Examens compl\u00e9mentaires d\u00e9j\u00e0 r\u00e9alis\u00e9s<\/label><span id=\"forminator-field-upload-1_6a2353ac6ab1f-description\" class=\"forminator-description\">T\u00e9l\u00e9chargez ici les documents (png, jpeg, pdf ou zip). Taille maximum de fichier : 2 MB.<\/span><div class=\"forminator-multi-upload \" data-element=\"upload-1_6a2353ac6ab1f\" aria-describedby=\"forminator-field-upload-1_6a2353ac6ab1f-description\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_6a2353ac6ab1f\" class=\"forminator-input-file forminator-field-upload-1_6a2353ac6ab1f-1348\" multiple=\"multiple\" data-method=\"ajax\" accept=\".avif,.heif,.heics,.heifs,.json,.svgz,.pdf,.jpg,.jpeg,.jpe,.png,.zip\" data-size=\"2000000\" data-size-message=\"Maximum file size allowed is 2 MB. \" data-filetype=\"avif|heif|heics|heifs|json|svgz|pdf|jpg|jpeg|jpe|png|zip\" data-filetype-message=\"l\u2019extension de fichier n\u2019est pas autoris\u00e9e.\"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Glissez et d\u00e9posez (ou) <a class=\"forminator-upload-file--forminator-field-upload-1_6a2353ac6ab1f\" href=\"#\" onclick=\"return false;\">Choisissez des fichiers<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-1_6a2353ac6ab1f\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a2353ac6ab1f\" id=\"forminator-field-textarea-3_6a2353ac6ab1f-label\" class=\"forminator-label\">Hypoth\u00e8ses diagnostiques<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a2353ac6ab1f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:155px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a2353ac6ab1f\" id=\"forminator-field-textarea-4_6a2353ac6ab1f-label\" class=\"forminator-label\">Traitements d\u00e9j\u00e0 administr\u00e9s<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a2353ac6ab1f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:155px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a2353ac6ab1f\" id=\"forminator-field-textarea-5_6a2353ac6ab1f-label\" class=\"forminator-label\">Remarques<\/label><span id=\"forminator-field-textarea-5_6a2353ac6ab1f-description\" class=\"forminator-description\">Risque anesth\u00e9sique particulier, allergie connue, etc.<\/span><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6a2353ac6ab1f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:155px;\" aria-describedby=\"forminator-field-textarea-5_6a2353ac6ab1f-description\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6a2353ac6ab1f\" id=\"forminator-field-consent-1_6a2353ac6ab1f-label\" class=\"forminator-label\">Confidentialit\u00e9 <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6a2353ac6ab1f__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_6a2353ac6ab1f-label\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a2353ac6ab1f\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6a2353ac6ab1f-label\" aria-describedby=\"forminator-field-consent-1_6a2353ac6ab1f__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a2353ac6ab1f__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>En remplissant ce formulaire, vous consentez \u00e0 ce que la Clinique V\u00e9t\u00e9rinaire de l'H\u00e9ritan collecte vos donn\u00e9es afin de pouvoir r\u00e9pondre \u00e0 votre message.<\/p><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"c3dc68720e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/vetoheritan\/wp-json\/wp\/v2\/pages\/1327\" \/><input type=\"hidden\" name=\"form_id\" value=\"1348\"><input type=\"hidden\" name=\"page_id\" value=\"1327\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/dev.peleweb.com\/vetoheritan\/referer-un-patient\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>R\u00e9f\u00e9rerun patient Vous souhaitez nous confier l\u2019un de vos patients pour un avis sp\u00e9cialis\u00e9 ? L\u2019\u00e9quipe de la Clinique de l\u2019H\u00e9ritan met ses comp\u00e9tences et son plateau technique \u00e0 votre disposition. Merci de remplir le formulaire ci-dessous. Attention, cette page est destin\u00e9e aux professionnels v\u00e9t\u00e9rinaires.Formulaire de r\u00e9f\u00e9r\u00e9Pour r\u00e9f\u00e9rer un cas v\u00e9t\u00e9rinaire en ligne, merci de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1988,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"class_list":["post-1327","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/pages\/1327","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/comments?post=1327"}],"version-history":[{"count":10,"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/pages\/1327\/revisions"}],"predecessor-version":[{"id":2003,"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/pages\/1327\/revisions\/2003"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/media\/1988"}],"wp:attachment":[{"href":"https:\/\/dev.peleweb.com\/vetoheritan\/wp-json\/wp\/v2\/media?parent=1327"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}