{"id":28515,"date":"2024-07-20T23:19:14","date_gmt":"2024-07-20T23:19:14","guid":{"rendered":"https:\/\/drburakkavlakoglu.com\/?page_id=28515"},"modified":"2024-08-21T10:26:52","modified_gmt":"2024-08-21T10:26:52","slug":"formulaire-de-consultation","status":"publish","type":"page","link":"https:\/\/drburakkavlakoglu.com\/fr\/formulaire-de-consultation\/","title":{"rendered":"Formulaire de consultation"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"28515\" class=\"elementor elementor-28515\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<div class=\"elementor-section elementor-top-section elementor-element elementor-element-be0c6cd elementor-section-stretched elementor-section-height-min-height elementor-section-items-top elementor-section-boxed elementor-section-height-default\" data-id=\"be0c6cd\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-100dcf1\" data-id=\"100dcf1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e0ae1c9 elementor-nav-menu--dropdown-tablet elementor-nav-menu__text-align-aside elementor-nav-menu--toggle elementor-nav-menu--burger elementor-widget elementor-widget-nav-menu\" data-id=\"e0ae1c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;layout&quot;:&quot;vertical&quot;,&quot;submenu_icon&quot;:{&quot;value&quot;:&quot;&lt;svg class=\\&quot;e-font-icon-svg e-fas-caret-down\\&quot; viewBox=\\&quot;0 0 320 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;toggle&quot;:&quot;burger&quot;}\" data-widget_type=\"nav-menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<nav class=\"elementor-nav-menu--main elementor-nav-menu__container elementor-nav-menu--layout-vertical e--pointer-underline e--animation-fade\">\n\t\t\t\t<ul id=\"menu-1-e0ae1c9\" class=\"elementor-nav-menu sm-vertical\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28960\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/biographie\/\" class=\"elementor-item\">Biographie<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28961\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/notre-politique-qualite\/\" class=\"elementor-item\">Notre Politique Qualit\u00e9<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28962\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/questions-frequemment-posees\/\" class=\"elementor-item\">Questions fr\u00e9quemment pos\u00e9es<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28978\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/nos-certificats\/\" class=\"elementor-item\">Nos certificats<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28979\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/politique-de-confidentialite\/\" class=\"elementor-item\">politique de confidentialit\u00e9<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28980\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/formulaire-de-consultation\/\" class=\"elementor-item\">Formulaire de consultation<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28981\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/des-articles\/\" class=\"elementor-item\">Des articles<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28982\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/videos-de-patients\/\" class=\"elementor-item\">Vid\u00e9os de patients<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t<div class=\"elementor-menu-toggle\" role=\"button\" tabindex=\"0\" aria-label=\"Menu Toggle\" aria-expanded=\"false\">\n\t\t\t<svg aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--open e-font-icon-svg e-eicon-menu-bar\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M104 333H896C929 333 958 304 958 271S929 208 896 208H104C71 208 42 237 42 271S71 333 104 333ZM104 583H896C929 583 958 554 958 521S929 458 896 458H104C71 458 42 487 42 521S71 583 104 583ZM104 833H896C929 833 958 804 958 771S929 708 896 708H104C71 708 42 737 42 771S71 833 104 833Z\"><\/path><\/svg><svg aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--close e-font-icon-svg e-eicon-close\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M742 167L500 408 258 167C246 154 233 150 217 150 196 150 179 158 167 167 154 179 150 196 150 212 150 229 154 242 171 254L408 500 167 742C138 771 138 800 167 829 196 858 225 858 254 829L496 587 738 829C750 842 767 846 783 846 800 846 817 842 829 829 842 817 846 804 846 783 846 767 842 750 829 737L588 500 833 258C863 229 863 200 833 171 804 137 775 137 742 167Z\"><\/path><\/svg>\t\t\t<span class=\"elementor-screen-only\">Menu<\/span>\n\t\t<\/div>\n\t\t\t\t\t<nav class=\"elementor-nav-menu--dropdown elementor-nav-menu__container\" aria-hidden=\"true\">\n\t\t\t\t<ul id=\"menu-2-e0ae1c9\" class=\"elementor-nav-menu sm-vertical\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28960\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/biographie\/\" class=\"elementor-item\" tabindex=\"-1\">Biographie<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28961\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/notre-politique-qualite\/\" class=\"elementor-item\" tabindex=\"-1\">Notre Politique Qualit\u00e9<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28962\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/questions-frequemment-posees\/\" class=\"elementor-item\" tabindex=\"-1\">Questions fr\u00e9quemment pos\u00e9es<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28978\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/nos-certificats\/\" class=\"elementor-item\" tabindex=\"-1\">Nos certificats<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28979\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/politique-de-confidentialite\/\" class=\"elementor-item\" tabindex=\"-1\">politique de confidentialit\u00e9<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28980\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/formulaire-de-consultation\/\" class=\"elementor-item\" tabindex=\"-1\">Formulaire de consultation<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28981\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/des-articles\/\" class=\"elementor-item\" tabindex=\"-1\">Des articles<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-28982\"><a href=\"https:\/\/drburakkavlakoglu.com\/fr\/videos-de-patients\/\" class=\"elementor-item\" tabindex=\"-1\">Vid\u00e9os de patients<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-564042a\" data-id=\"564042a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f3b3ca2 elementor-widget elementor-widget-heading\" data-id=\"f3b3ca2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Obtenez des Conseils<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8cd6cdb elementor-button-align-start elementor-mobile-button-align-center elementor-widget elementor-widget-form\" data-id=\"8cd6cdb\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"28515\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"8cd6cdb\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Formulaire de consultation\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"28515\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom Pr\u00e9nom *\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<span class=\"ccfef-editor-intl-input\" data-id=\"form-field-email\" data-field-id=\"fc0ae70\" data-default-country=\"us\" data-include-countries=\"\" data-exclude-countries=\"\" data-dial-code-visibility=\"show\" data-strict-mode=\"no\" style=\"display: none;\"><\/span>\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"+90\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_ba0dc78 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_ba0dc78]\" id=\"form-field-field_ba0dc78\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"E-Mail *\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_cb54d9f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_cb54d9f]\" id=\"form-field-field_cb54d9f\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\"Veuillez s\u00e9lectionner le service que vous souhaitez recevoir\">Veuillez s\u00e9lectionner le service que vous souhaitez recevoir<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chirurgie du manchon gastrique\">Chirurgie du manchon gastrique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bypass gastrique\">Bypass gastrique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mini-bypass gastrique\">Mini-bypass gastrique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bariclip (clip gastrique)\">Bariclip (clip gastrique)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gastroplastie endoscopique\">Gastroplastie endoscopique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ballon gastrique\">Ballon gastrique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chirurgie du diab\u00e8te\">Chirurgie du diab\u00e8te<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chirurgie m\u00e9tabolique\">Chirurgie m\u00e9tabolique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chirurgie bipartition de transit\">Chirurgie bipartition de transit<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_5e54900 elementor-col-100\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_5e54900]\" id=\"form-field-field_5e54900\" rows=\"6\" placeholder=\"Votre Message\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Obtenez des Conseils<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-28515","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/pages\/28515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/comments?post=28515"}],"version-history":[{"count":0,"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/pages\/28515\/revisions"}],"wp:attachment":[{"href":"https:\/\/drburakkavlakoglu.com\/fr\/wp-json\/wp\/v2\/media?parent=28515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}