{"id":739,"date":"2025-05-07T22:11:36","date_gmt":"2025-05-07T20:11:36","guid":{"rendered":"https:\/\/ia-chirurgien.myesthetictravel.net\/form\/"},"modified":"2025-05-07T22:13:25","modified_gmt":"2025-05-07T20:13:25","slug":"form","status":"publish","type":"page","link":"https:\/\/ia-chirurgien.myesthetictravel.net\/en\/form\/","title":{"rendered":"Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"739\" class=\"elementor elementor-739 elementor-737\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-309b8a6 e-flex e-con-boxed e-con e-parent\" data-id=\"309b8a6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c878e21 elementor-widget elementor-widget-heading\" data-id=\"c878e21\" 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<h1 class=\"elementor-heading-title elementor-size-default\">Request form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f63beeb elementor-widget elementor-widget-wpforms\" data-id=\"f63beeb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-f63beeb\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-f63beeb {\n\t\t\t\t--wpforms-button-background-color: #42B69C;\n--wpforms-button-size-font-size: 20px;\n--wpforms-button-size-height: 48px;\n--wpforms-button-size-padding-h: 20px;\n--wpforms-button-size-margin-top: 15px;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-597\"><form id=\"wpforms-form-597\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"597\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/739\" data-token=\"fe8b9a90fe4d2a3755472518bb158550\" data-token-time=\"1777042902\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-597-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-597-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" placeholder=\"First name\" aria-errormessage=\"wpforms-597-field_1-error\" required><label for=\"wpforms-597-field_1\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-597-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" placeholder=\"Name\" aria-errormessage=\"wpforms-597-field_1-last-error\" required><label for=\"wpforms-597-field_1-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-597-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"5\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-597-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_3\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-597-field_3\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" aria-errormessage=\"wpforms-597-field_3-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-597-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_4\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-597-field_4\" class=\"wpforms-field-small wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-597-field_4-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-597-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Do you have an assistant? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-597-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-597-field_6_1\" name=\"wpforms[fields][6]\" value=\"Yes\" aria-errormessage=\"wpforms-597-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-597-field_6_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-597-field_6_2\" name=\"wpforms[fields][6]\" value=\"No\" aria-errormessage=\"wpforms-597-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-597-field_6_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-597-field_7-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_7\">How many assistants? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-597-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" step=\"any\" aria-errormessage=\"wpforms-597-field_7-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-597-field_8-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_8\">Your sales are at: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-597-field_8\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][8]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Please select<\/option><option value=\"-50k\" >-50k<\/option><option value=\"-100k\" >-100k<\/option><option value=\"+100k\" >+100k<\/option><\/select><\/div><div id=\"wpforms-597-field_9-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_9\">What languages would you like your IA Binomial to speak? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-597-field_9\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][9][]\" required=\"required\" multiple=\"multiple\"><option value=\"\" class=\"placeholder\" disabled >Please select<\/option><option value=\"French\" >French<\/option><option value=\"English\" >English<\/option><option value=\"Spanish\" >Spanish<\/option><option value=\"German\" >German<\/option><option value=\"Arabic\" >Arabic<\/option><option value=\"Chinese\" >Chinese<\/option><option value=\"Other\" >Other<\/option><\/select><\/div><div id=\"wpforms-597-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_12\">What&#039;s important to you? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-597-field_12\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][12][]\" required=\"required\" multiple=\"multiple\"><option value=\"\" class=\"placeholder\" disabled >Please select<\/option><option value=\"A 24-hour presence for your patients\" >A 24-hour presence for your patients<\/option><option value=\"Increase your sales by 30%.\" >Increase your sales by 30%.<\/option><option value=\"Differentiate your approach and offer your patients a unique experience\" >Differentiate your approach and offer your patients a unique experience<\/option><option value=\"Become or remain the undisputed leader in your sector\" >Become or remain the undisputed leader in your sector<\/option><option value=\"Premium image\" >Premium image<\/option><\/select><\/div><div id=\"wpforms-597-field_13-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_13\">What do you need? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-597-field_13\" 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day<\/option><\/select><\/div><div id=\"wpforms-597-field_16-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-597-field_16\">Do you have a website? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-597-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Please select<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div>\t\t<div id=\"wpforms-597-field_10-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"10\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-597-field_10\" >teams? at: assistant?<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-597-field_10\" 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