{"id":1076,"date":"2018-03-01T16:29:47","date_gmt":"2018-03-01T21:29:47","guid":{"rendered":"http:\/\/periomontreal.com\/?page_id=1076"},"modified":"2018-04-02T10:17:02","modified_gmt":"2018-04-02T14:17:02","slug":"reference","status":"publish","type":"page","link":"https:\/\/periomontreal.com\/fr\/reference\/","title":{"rendered":"R\u00e9f\u00e9rence"},"content":{"rendered":"<p>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1075-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1075\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/1076#wpcf7-f1075-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1075\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1075-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>R\u00e9f\u00e9r\u00e9 \u00e0\n<\/h3>\n<p><label> <span class=\"wpcf7-form-control-wrap\" data-name=\"referring-dentist\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"referring-dentist\"><option value=\"Selon disponibilit\u00e9\">Selon disponibilit\u00e9<\/option><option value=\"Dr. Jeremy S. Werbitt\">Dr. Jeremy S. Werbitt<\/option><option value=\"Dr. Bram Salis\">Dr. Bram Salis<\/option><option value=\"Dr. Edward H Trinh\">Dr. Edward H Trinh<\/option><option value=\"Dr. Genevi\u00e8ve Payne\">Dr. Genevi\u00e8ve Payne<\/option><option value=\"Dr. Firoozeh Samim\">Dr. Firoozeh Samim<\/option><\/select><\/span> <\/label>\n<\/p>\n<h3>Dentiste R\u00e9f\u00e9rent\n<\/h3>\n<p><label> Pr\u00e9nom <span class=\"wpcf7-form-control-wrap\" data-name=\"dentist-first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dentist-first-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nom <span class=\"wpcf7-form-control-wrap\" data-name=\"dentist-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dentist-last-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Clinique <span class=\"wpcf7-form-control-wrap\" data-name=\"referring-clinic\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"referring-clinic\" \/><\/span> <\/label>\n<\/p>\n<p><label> T\u00e9l\u00e9phone <span class=\"wpcf7-form-control-wrap\" data-name=\"referring-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"referring-phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Courriel <span class=\"wpcf7-form-control-wrap\" data-name=\"referring-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"referring-email\" \/><\/span> <\/label>\n<\/p>\n<h3>Patient\n<\/h3>\n<p><label> Pr\u00e9nom <span class=\"wpcf7-form-control-wrap\" data-name=\"patient-first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-first-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Nom <span class=\"wpcf7-form-control-wrap\" data-name=\"patient-last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-last-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> T\u00e9l\u00e9phone <span class=\"wpcf7-form-control-wrap\" data-name=\"patient-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"patient-phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Courriel <span class=\"wpcf7-form-control-wrap\" data-name=\"patient-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"patient-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> R\u00e9f\u00e9r\u00e9 pour <span class=\"wpcf7-form-control-wrap\" data-name=\"reason\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"reason\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"\u00c9valuation g\u00e9n\u00e9rale\">\u00c9valuation g\u00e9n\u00e9rale<\/option><option value=\"Recouvrement esth\u00e9tique de racine\">Recouvrement esth\u00e9tique de racine<\/option><option value=\"Occlusion\">Occlusion<\/option><option value=\"\u00c9longation de la couronne\">\u00c9longation de la couronne<\/option><option value=\"R\u00e9g\u00e9n\u00e9ration tissulaire\">R\u00e9g\u00e9n\u00e9ration tissulaire<\/option><option value=\"Implant\">Implant<\/option><option value=\"Traitement d&#039;urgence\">Traitement d&#039;urgence<\/option><option value=\"Probl\u00e8me muco-gingival\">Probl\u00e8me muco-gingival<\/option><option value=\"A.T.M.\">A.T.M.<\/option><option value=\"Augmentation de la cr\u00eate\">Augmentation de la cr\u00eate<\/option><option value=\"\u00c9limination des poches\">\u00c9limination des poches<\/option><option value=\"Autre\">Autre<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Dent(s) <span class=\"wpcf7-form-control-wrap\" data-name=\"teeth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"teeth\" \/><\/span> <\/label>\n<\/p>\n<p><label> Commentaires <span class=\"wpcf7-form-control-wrap\" data-name=\"comments\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"comments\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><span id=\"wpcf7-69d4c66861b06-wrapper\" class=\"wpcf7-form-control-wrap website-wrap\" style=\"display:none !important; visibility:hidden !important;\"><input type=\"hidden\" name=\"website-time-start\" value=\"1775552104\"><input type=\"hidden\" name=\"website-time-check\" value=\"8\"><label for=\"wpcf7-69d4c66861b06-field\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"wpcf7-69d4c66861b06-field\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"website\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n<script>\n   var submitbutton = document.getElementsByClassName(\"wpcf7-submit\")[0];\n   submitbutton.addEventListener(\"click\", function(e) {\n       var tracker = ga.getAll()[0];\n       tracker.send('event', 'periomontreal', 'referralsSubmitFR');  \n       console.log(\"Referrals Button Click\");\n   }, false);\n<\/script><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"class_list":{"0":"post-1076","1":"page","2":"type-page","3":"status-publish","5":"entry"},"_links":{"self":[{"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/pages\/1076","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/comments?post=1076"}],"version-history":[{"count":3,"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/pages\/1076\/revisions"}],"predecessor-version":[{"id":1110,"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/pages\/1076\/revisions\/1110"}],"wp:attachment":[{"href":"https:\/\/periomontreal.com\/fr\/wp-json\/wp\/v2\/media?parent=1076"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}