{"id":3932,"date":"2021-09-20T09:25:05","date_gmt":"2021-09-20T13:25:05","guid":{"rendered":"https:\/\/lepont.com\/intervenant-du-milieu\/"},"modified":"2021-10-13T10:13:45","modified_gmt":"2021-10-13T14:13:45","slug":"intervenant-du-milieu","status":"publish","type":"page","link":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/","title":{"rendered":"Fellow Counsellors"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3932\" class=\"elementor elementor-3932 elementor-2128\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"ob-is-breaking-bad elementor-section elementor-top-section elementor-element elementor-element-7916127 elementor-section-height-min-height elementor-section-full_width elementor-section-height-default elementor-section-items-middle\" data-id=\"7916127\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&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-eba3ee9\" data-id=\"eba3ee9\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\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-6006be6 ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"6006be6\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Intervenant du milieu<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-27e856c ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"27e856c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" 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\">Vous avez un membre de l'entourage \u00e0 nous r\u00e9f\u00e9rer?<\/h1>\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-f5f9600\" data-id=\"f5f9600\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"ob-is-breaking-bad elementor-section elementor-top-section elementor-element elementor-element-f8ae18e elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"f8ae18e\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7f1c01d3\" data-id=\"7f1c01d3\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\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-446b0a45 ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"446b0a45\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" 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\">Formulaire<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"ob-is-breaking-bad ob-bb-inner elementor-section elementor-inner-section elementor-element elementor-element-5bf03c23 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"5bf03c23\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-7b20c644\" data-id=\"7b20c644\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\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-6fcc6514 uael-gf-ajax-yes uael-gf-input-size-md uael-gf-button-right uael-gf-btn-size-md uael-gf-style-box uael-gf-enable-classes-no ob-has-background-overlay elementor-widget elementor-widget-uael-gf-styler\" data-id=\"6fcc6514\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/en\/wp-json\/wp\/v2\/pages\/3932#gf_2' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_55\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_2_55' class='ginput_container ginput_complex gform-grid-row'>\n                                        <div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_2_55_3_container'>\n                                            <input type='number' maxlength='4' name='input_55[]' id='input_2_55_3' value='' tabindex='1'  aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_2_55_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                        <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_2_55_1_container'>\n                                            <input type='number' maxlength='2' name='input_55[]' id='input_2_55_1' value='' tabindex='2'  aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_2_55_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_2_55_2_container'>\n                                            <input type='number' maxlength='2' name='input_55[]' id='input_2_55_2' value='' tabindex='3'  aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_2_55_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                       <\/div>\n                                    <\/div><\/fieldset><fieldset id=\"field_2_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Je suis...<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_2'>\n                            \n                            <span id='input_2_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_2_2_3' value='' tabindex='5'  aria-required='true'     \/>\n                                                    <label for='input_2_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_2_2_6' value='' tabindex='7'  aria-required='true'     \/>\n                                                    <label for='input_2_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_56'><span class='gform-field-label__text'>Institution \/ organisme<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_2_56' type='text' value='' class='large'   tabindex='9'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Identification de la personne r\u00e9f\u00e9r\u00e9e<\/h3><\/div><fieldset id=\"field_2_45\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Je vous r\u00e9f\u00e8re<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_45'>\n                            \n                            <span id='input_2_45_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.3' id='input_2_45_3' value='' tabindex='11'  aria-required='true'     \/>\n                                                    <label for='input_2_45_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_45_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.6' id='input_2_45_6' value='' tabindex='13'  aria-required='true'     \/>\n                                                    <label for='input_2_45_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'><span class='gform-field-label__text'>Qui habite<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_2_10' class='large gfield_select' tabindex='15'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Beauharnois' >Beauharnois<\/option><option value='Coteau-du-Lac' >Coteau-du-Lac<\/option><option value='Dundee' >Dundee<\/option><option value='Elgin' >Elgin<\/option><option value='Franklin' >Franklin<\/option><option value='Godmanchester' >Godmanchester<\/option><option value='Havelock' >Havelock<\/option><option value='Hinchinbrook' >Hinchinbrook<\/option><option value='Howick' >Howick<\/option><option value='Huntingdon' >Huntingdon<\/option><option value='Ormstown' >Ormstown<\/option><option value='Hudson' >Hudson<\/option><option value='Les C\u00e8dres' >Les C\u00e8dres<\/option><option value='Les Coteaux' >Les Coteaux<\/option><option value='L&#039;Ile-Cadieux' >L&#039;Ile-Cadieux<\/option><option value='Notre-Dame-de-L&#039;Ile-Perr\u00f4t' >Notre-Dame-de-L&#039;Ile-Perr\u00f4t<\/option><option value='Pincourt' >Pincourt<\/option><option value='Pointe-des-Cascades' >Pointe-des-Cascades<\/option><option value='Pointe-Fortune' >Pointe-Fortune<\/option><option value='Rigaud' >Rigaud<\/option><option value='Rivi\u00e8re-Beaudette' >Rivi\u00e8re-Beaudette<\/option><option value='Saint-Anicet' >Saint-Anicet<\/option><option value='Saint-Chrysostome' >Saint-Chrysostome<\/option><option value='Saint-Clet' >Saint-Clet<\/option><option value='Saint-Etienne-de-Beauharnois' >Saint-Etienne-de-Beauharnois<\/option><option value='Saint-Lazare' >Saint-Lazare<\/option><option value='Saint-Louis-de-Gonzague' >Saint-Louis-de-Gonzague<\/option><option value='Saint-Polycarpe' >Saint-Polycarpe<\/option><option value='Saint-Stanislas-de-Kostka' >Saint-Stanislas-de-Kostka<\/option><option value='Saint-T\u00e9lesphore' >Saint-T\u00e9lesphore<\/option><option value='Saint-Zotique' >Saint-Zotique<\/option><option value='Sainte-Barbe' >Sainte-Barbe<\/option><option value='Sainte-Justine-de-Newton' >Sainte-Justine-de-Newton<\/option><option value='Sainte-Marthe' >Sainte-Marthe<\/option><option value='Salaberry-de-Valleyfield' >Salaberry-de-Valleyfield<\/option><option value='Terrasse-Vaudreuil' >Terrasse-Vaudreuil<\/option><option value='Tr\u00e8s-Saint-R\u00e9dempteur' >Tr\u00e8s-Saint-R\u00e9dempteur<\/option><option value='Tr\u00e8s-Saint-Sacrement' >Tr\u00e8s-Saint-Sacrement<\/option><option value='Vaudreuil-Dorion' >Vaudreuil-Dorion<\/option><option value='Vaudreuil-sur-Le-Lac' >Vaudreuil-sur-Le-Lac<\/option><option value='Autre r\u00e9gion' >Autre r\u00e9gion<\/option><\/select><\/div><\/div><div id=\"field_2_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_22'><span class='gform-field-label__text'>Autre r\u00e9gion (Pr\u00e9cisez)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_2_22' type='text' value='' class='large'   tabindex='16'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_8\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_2_8' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_8_1_container' >\n                                        <input type='text' name='input_8.1' id='input_2_8_1' value='' tabindex='17'   aria-required='true'    \/>\n                                        <label for='input_2_8_1' id='input_2_8_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_8_3_container' >\n                                    <input type='text' name='input_8.3' id='input_2_8_3' value='' tabindex='18'   aria-required='true'    \/>\n                                    <label for='input_2_8_3' id='input_2_8_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_8.4' id='input_2_8_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_2_8_5_container' >\n                                    <input type='text' name='input_8.5' id='input_2_8_5' value='' tabindex='19'   aria-required='true'    \/>\n                                    <label for='input_2_8_5' id='input_2_8_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_2_8_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_2_27\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_27'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_27' id='input_2_27' type='email' value='' class='large' tabindex='20'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_28\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_28'><span class='gform-field-label__text'>T\u00e9l\u00e9phone (Maison)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_28' id='input_2_28' type='tel' value='' class='large' tabindex='21' placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_2_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Peut-on laisser un message ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_30'>\n\t\t\t<div class='gchoice gchoice_2_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Oui'  id='choice_2_30_0' onchange='gformToggleRadioOther( this )'  tabindex='22'  \/>\n\t\t\t\t\t<label for='choice_2_30_0' id='label_2_30_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Non'  id='choice_2_30_1' onchange='gformToggleRadioOther( this )'  tabindex='23'  \/>\n\t\t\t\t\t<label for='choice_2_30_1' id='label_2_30_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_31\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_31'><span class='gform-field-label__text'>T\u00e9l\u00e9phone (Cellulaire)<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_31' id='input_2_31' type='tel' value='' class='large' tabindex='24' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_2_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Peut-on laisser un message ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_32'>\n\t\t\t<div class='gchoice gchoice_2_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Oui'  id='choice_2_32_0' onchange='gformToggleRadioOther( this )'  tabindex='25'  \/>\n\t\t\t\t\t<label for='choice_2_32_0' id='label_2_32_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Non'  id='choice_2_32_1' onchange='gformToggleRadioOther( this )'  tabindex='26'  \/>\n\t\t\t\t\t<label for='choice_2_32_1' id='label_2_32_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_33\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_33'><span class='gform-field-label__text'>T\u00e9l\u00e9phone (Travail)<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_33' id='input_2_33' type='tel' value='' class='large' tabindex='27' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_2_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Peut-on laisser un message ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_34'>\n\t\t\t<div class='gchoice gchoice_2_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Oui'  id='choice_2_34_0' onchange='gformToggleRadioOther( this )'  tabindex='28'  \/>\n\t\t\t\t\t<label for='choice_2_34_0' id='label_2_34_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Non'  id='choice_2_34_1' onchange='gformToggleRadioOther( this )'  tabindex='29'  \/>\n\t\t\t\t\t<label for='choice_2_34_1' id='label_2_34_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Langue(s) parl\u00e9e(s)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_11'>\n\t\t\t<div class='gchoice gchoice_2_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Fran\u00e7ais'  id='choice_2_11_0' onchange='gformToggleRadioOther( this )'  tabindex='30'  \/>\n\t\t\t\t\t<label for='choice_2_11_0' id='label_2_11_0' class='gform-field-label gform-field-label--type-inline'>Fran\u00e7ais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Anglais'  id='choice_2_11_1' onchange='gformToggleRadioOther( this )'  tabindex='31'  \/>\n\t\t\t\t\t<label for='choice_2_11_1' id='label_2_11_1' class='gform-field-label gform-field-label--type-inline'>Anglais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gf_other_choice'  id='choice_2_11_2' onchange='gformToggleRadioOther( this )'  tabindex='32'  \/>\n\t\t\t\t\t<label for='choice_2_11_2' id='label_2_11_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_11_other' class='gchoice_other_control' name='input_11_other' type='text' value='Other' aria-label='Other Choice, please specify' tabindex='32' disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Cette personne est :<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_12'>\n\t\t\t<div class='gchoice gchoice_2_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='le p\u00e8re \/ m\u00e8re'  id='choice_2_12_0' onchange='gformToggleRadioOther( this )'  tabindex='33'  \/>\n\t\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>le p\u00e8re \/ m\u00e8re<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='le conjoint(e)'  id='choice_2_12_1' onchange='gformToggleRadioOther( this )'  tabindex='34'  \/>\n\t\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>le conjoint(e)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='l&#039;enfant de'  id='choice_2_12_2' onchange='gformToggleRadioOther( this )'  tabindex='35'  \/>\n\t\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>l'enfant de<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='un(e) ami(e)'  id='choice_2_12_3' onchange='gformToggleRadioOther( this )'  tabindex='36'  \/>\n\t\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>un(e) ami(e)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='un membre de la fratrie'  id='choice_2_12_4' onchange='gformToggleRadioOther( this )'  tabindex='37'  \/>\n\t\t\t\t\t<label for='choice_2_12_4' id='label_2_12_4' class='gform-field-label gform-field-label--type-inline'>un membre de la fratrie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='gf_other_choice'  id='choice_2_12_5' onchange='gformToggleRadioOther( this )'  tabindex='38'  \/>\n\t\t\t\t\t<label for='choice_2_12_5' id='label_2_12_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_12_other' class='gchoice_other_control' name='input_12_other' type='text' value='Other' aria-label='Other Choice, please specify' tabindex='38' disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">La personne ayant une probl\u00e9matique de sant\u00e9 mentale<\/h3><\/div><fieldset id=\"field_2_36\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom de la personne atteinte<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_36'>\n                            \n                            <span id='input_2_36_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.3' id='input_2_36_3' value='' tabindex='40'  aria-required='false'     \/>\n                                                    <label for='input_2_36_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_36_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.6' id='input_2_36_6' value='' tabindex='42'  aria-required='false'     \/>\n                                                    <label for='input_2_36_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_37'><span class='gform-field-label__text'>\u00c2ge de la personne atteinte<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_2_37' class='large gfield_select' tabindex='44'    aria-invalid=\"false\" ><option value='0-13 ans' >0-13 ans<\/option><option value='14-17 ans' >14-17 ans<\/option><option value='18-30 ans' >18-30 ans<\/option><option value='31-64 ans' >31-64 ans<\/option><option value='65 ans +' >65 ans +<\/option><\/select><\/div><\/div><fieldset id=\"field_2_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Cette personne vit dans sa famille ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_38'>\n\t\t\t<div class='gchoice gchoice_2_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Oui'  id='choice_2_38_0' onchange='gformToggleRadioOther( this )'  tabindex='45'  \/>\n\t\t\t\t\t<label for='choice_2_38_0' id='label_2_38_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Non'  id='choice_2_38_1' onchange='gformToggleRadioOther( this )'  tabindex='46'  \/>\n\t\t\t\t\t<label for='choice_2_38_1' id='label_2_38_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_38_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Je ne sais pas'  id='choice_2_38_2' onchange='gformToggleRadioOther( this )'  tabindex='47'  \/>\n\t\t\t\t\t<label for='choice_2_38_2' id='label_2_38_2' class='gform-field-label gform-field-label--type-inline'>Je ne sais pas<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Cette personne souffre de :<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_42'><div class='gchoice gchoice_2_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='D\u00e9pression'  id='choice_2_42_1' tabindex='48'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_1' id='label_2_42_1' class='gform-field-label gform-field-label--type-inline'>D\u00e9pression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='\u00c9pisode psychotique'  id='choice_2_42_2' tabindex='49'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_2' id='label_2_42_2' class='gform-field-label gform-field-label--type-inline'>\u00c9pisode psychotique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='Schizophr\u00e9nie'  id='choice_2_42_3' tabindex='50'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_3' id='label_2_42_3' class='gform-field-label gform-field-label--type-inline'>Schizophr\u00e9nie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='Trouble bipolaire'  id='choice_2_42_4' tabindex='51'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_4' id='label_2_42_4' class='gform-field-label gform-field-label--type-inline'>Trouble bipolaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='Trouble obsessionnel-compulsif'  id='choice_2_42_5' tabindex='52'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_5' id='label_2_42_5' class='gform-field-label gform-field-label--type-inline'>Trouble obsessionnel-compulsif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.6' type='checkbox'  value='Trouble de personnalit\u00e9 limite'  id='choice_2_42_6' tabindex='53'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_6' id='label_2_42_6' class='gform-field-label gform-field-label--type-inline'>Trouble de personnalit\u00e9 limite<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_42_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.7' type='checkbox'  value='Autre'  id='choice_2_42_7' tabindex='54'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_42_7' id='label_2_42_7' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_46'><span class='gform-field-label__text'>Autre (Pr\u00e9cisez)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'   tabindex='55'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Le diagnostic est confirm\u00e9 ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_40'>\n\t\t\t<div class='gchoice gchoice_2_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Oui'  id='choice_2_40_0' onchange='gformToggleRadioOther( this )'  tabindex='56'  \/>\n\t\t\t\t\t<label for='choice_2_40_0' id='label_2_40_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Non'  id='choice_2_40_1' onchange='gformToggleRadioOther( this )'  tabindex='57'  \/>\n\t\t\t\t\t<label for='choice_2_40_1' id='label_2_40_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Je ne sais pas'  id='choice_2_40_2' onchange='gformToggleRadioOther( this )'  tabindex='58'  \/>\n\t\t\t\t\t<label for='choice_2_40_2' id='label_2_40_2' class='gform-field-label gform-field-label--type-inline'>Je ne sais pas<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Probl\u00e8mes concomitants ?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_43'><div class='gchoice gchoice_2_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Aucun'  id='choice_2_43_1' tabindex='59'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_1' id='label_2_43_1' class='gform-field-label gform-field-label--type-inline'>Aucun<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='D.I. l\u00e9g\u00e8re'  id='choice_2_43_2' tabindex='60'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_2' id='label_2_43_2' class='gform-field-label gform-field-label--type-inline'>D.I. l\u00e9g\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='D\u00e9but de d\u00e9mence'  id='choice_2_43_3' tabindex='61'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_3' id='label_2_43_3' class='gform-field-label gform-field-label--type-inline'>D\u00e9but de d\u00e9mence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_43_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.4' type='checkbox'  value='D\u00e9pendances'  id='choice_2_43_4' tabindex='62'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_4' id='label_2_43_4' class='gform-field-label gform-field-label--type-inline'>D\u00e9pendances<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Traumatisme cr\u00e2nien'  id='choice_2_43_5' tabindex='63'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_5' id='label_2_43_5' class='gform-field-label gform-field-label--type-inline'>Traumatisme cr\u00e2nien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_43_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.6' type='checkbox'  value='Autre'  id='choice_2_43_6' tabindex='64'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_43_6' id='label_2_43_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_44'><span class='gform-field-label__text'>Autre probl\u00e8me (Pr\u00e9cisez)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='large'   tabindex='65'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Motifs de la r\u00e9f\u00e9rence<\/h3><\/div><fieldset id=\"field_2_48\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Intervention psychosociale<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_48'><div class='gchoice gchoice_2_48_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.1' type='checkbox'  value='Counseling individuel'  id='choice_2_48_1' tabindex='66'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_1' id='label_2_48_1' class='gform-field-label gform-field-label--type-inline'>Counseling individuel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.2' type='checkbox'  value='Counseling familial'  id='choice_2_48_2' tabindex='67'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_2' id='label_2_48_2' class='gform-field-label gform-field-label--type-inline'>Counseling familial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.3' type='checkbox'  value='Counseling de couple'  id='choice_2_48_3' tabindex='68'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_3' id='label_2_48_3' class='gform-field-label gform-field-label--type-inline'>Counseling de couple<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.4' type='checkbox'  value='Autre'  id='choice_2_48_4' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_4' id='label_2_48_4' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_49'><span class='gform-field-label__text'>Autre motif (Pr\u00e9cisez)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_2_49' type='text' value='' class='large'   tabindex='70'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Pistes d&#039;interventions attendues<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_50'><div class='gchoice gchoice_2_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='Gestion des \u00e9motions'  id='choice_2_50_1' tabindex='71'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_1' id='label_2_50_1' class='gform-field-label gform-field-label--type-inline'>Gestion des \u00e9motions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='G\u00e9rer les crises d&#039;agressivit\u00e9'  id='choice_2_50_2' tabindex='72'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_2' id='label_2_50_2' class='gform-field-label gform-field-label--type-inline'>G\u00e9rer les crises d'agressivit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='Apprendre \u00e0 mettre en place des limites'  id='choice_2_50_3' tabindex='73'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_3' id='label_2_50_3' class='gform-field-label gform-field-label--type-inline'>Apprendre \u00e0 mettre en place des limites<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='Apprendre \u00e0 se prot\u00e9ger'  id='choice_2_50_4' tabindex='74'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_4' id='label_2_50_4' class='gform-field-label gform-field-label--type-inline'>Apprendre \u00e0 se prot\u00e9ger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='Gestion de la culpabilit\u00e9'  id='choice_2_50_5' tabindex='75'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_5' id='label_2_50_5' class='gform-field-label gform-field-label--type-inline'>Gestion de la culpabilit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='Autre'  id='choice_2_50_6' tabindex='76'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_6' id='label_2_50_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_51'><span class='gform-field-label__text'>Autre pistes (Pr\u00e9cisez)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_2_51' type='text' value='' class='large'   tabindex='77'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_52\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_52'><span class='gform-field-label__text'>Voici d&#039;autres informations qui pourront vous \u00eatre utiles<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_2_52' class='textarea large' tabindex='78'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">R\u00e9troaction<\/h3><\/div><fieldset id=\"field_2_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>J&#039;aimerais avoir une r\u00e9troaction<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Par courriel'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'  tabindex='79'  \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_0' class='gform-field-label gform-field-label--type-inline'>Par courriel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Par t\u00e9l\u00e9phone'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'  tabindex='80'  \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>Par t\u00e9l\u00e9phone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Non, merci'  id='choice_2_14_2' onchange='gformToggleRadioOther( this )'  tabindex='81'  \/>\n\t\t\t\t\t<label for='choice_2_14_2' id='label_2_14_2' class='gform-field-label gform-field-label--type-inline'>Non, merci<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_15\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_15'><span class='gform-field-label__text'>Mon adresse courriel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_2_15' type='email' value='' class='large' tabindex='82'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_17'><span class='gform-field-label__text'>Mon t\u00e9l\u00e9phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_2_17' type='tel' value='' class='large' tabindex='83' placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_2_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_18'><span class='gform-field-label__text'>Poste<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'   tabindex='84'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_19\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Autorisation<\/h3><div class='gsection_description' id='gfield_description_2_19'>La personne a \u00e9t\u00e9 inform\u00e9 que le Pont du Suro\u00eet travaille en collaboration avec le r\u00e9f\u00e9rent et autorise la transmission d\u2019information entre les partenaires et qu'un dossier sera ouvert \u00e0 son nom.<\/div><\/div><fieldset id=\"field_2_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>La personne a consenti<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_20'>\n\t\t\t<div class='gchoice gchoice_2_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Verbalement'  id='choice_2_20_0' onchange='gformToggleRadioOther( this )'  tabindex='85'  \/>\n\t\t\t\t\t<label for='choice_2_20_0' id='label_2_20_0' class='gform-field-label gform-field-label--type-inline'>Verbalement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Par \u00e9crit'  id='choice_2_20_1' onchange='gformToggleRadioOther( this )'  tabindex='86'  \/>\n\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>Par \u00e9crit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='N&#039;a pas consenti'  id='choice_2_20_2' onchange='gformToggleRadioOther( this )'  tabindex='87'  \/>\n\t\t\t\t\t<label for='choice_2_20_2' id='label_2_20_2' class='gform-field-label gform-field-label--type-inline'>N'a pas consenti<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_53\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_53'><span class='gform-field-label__text'>Fichier \u00e0 joindre<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='268435456' \/><input name='input_53' id='input_2_53' type='file' class='large' aria-describedby=\"gfield_upload_rules_2_53 gfield_description_2_53\" onchange='javascript:gformValidateFileSize( this, 268435456 );' tabindex='88' \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_53'>Max. file size: 256 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_2_53'><\/div> <\/div><div class='gfield_description' id='gfield_description_2_53'>Si vous avez un formulaire de consentement de transfert d'informations \u00e0 nous faire parvenir, vous pouvez le t\u00e9l\u00e9charger ici.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' tabindex='89'>Soumettre<\/button> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=1&amp;theme=gravity-theme&amp;styles=[]&amp;hash=15f7e8f67105082bc8cd6adbda235e74' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='gwAeESeEVOD0QuNx6M2kdyGdo6gO85mbuRqzlSOIGnejBNV+FEcg3dAkMokkmpVzye3DHwvH\/1j+l6fkcNkbihyZwD2ZKZJG+QV4Rmc0qhm2Wa0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );var current_page = jQuery('#gform_source_page_number_2').val();jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_2\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 2, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n\n<\/div>\n\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<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Intervenant du milieu Vous avez un membre de l&#8217;entourage \u00e0 nous r\u00e9f\u00e9rer? Formulaire Je suis&#8230;* Pr\u00e9nom Nom Titre professionnel*Intervenante socialeTravailleuse sociale\u00c9ducatrice sp\u00e9cialis\u00e9eM\u00e9decin g\u00e9n\u00e9ralistePsychiatreInfirmi\u00e8reAutreAutre titre (Pr\u00e9cisez) \u00c9tablissement \/ Organisme*Centre de criseCentre hospitalierClinique externe de psychiatrieCLSCOrganisme communautaireAutreAutre \u00e9tablissement (Pr\u00e9cisez) Service \/ D\u00e9partement*\u00c9quipe Premier \u00c9pisode PsychotiqueServices sociaux courantSuivi dans le milieu (SIM)Suivi d&#039;intensit\u00e9 variable (SIV)Unit\u00e9 de psychiatrieAutreAutre service [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-3932","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet<\/title>\n<meta name=\"description\" content=\"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lepont.com\/en\/intervenant-du-milieu\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet\" \/>\n<meta property=\"og:description\" content=\"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lepont.com\/en\/intervenant-du-milieu\/\" \/>\n<meta property=\"og:site_name\" content=\"Pont du Suro\u00eet\" \/>\n<meta property=\"article:modified_time\" content=\"2021-10-13T14:13:45+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/intervenant-du-milieu\\\/\",\"url\":\"https:\\\/\\\/lepont.com\\\/en\\\/intervenant-du-milieu\\\/\",\"name\":\"Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#website\"},\"datePublished\":\"2021-09-20T13:25:05+00:00\",\"dateModified\":\"2021-10-13T14:13:45+00:00\",\"description\":\"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/intervenant-du-milieu\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/lepont.com\\\/en\\\/intervenant-du-milieu\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/intervenant-du-milieu\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\\\/\\\/lepont.com\\\/en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Fellow Counsellors\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#website\",\"url\":\"https:\\\/\\\/lepont.com\\\/en\\\/\",\"name\":\"Pont du Suro\u00eet\",\"description\":\"Centre d&#039;intervention psychosociale\",\"publisher\":{\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/lepont.com\\\/en\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#organization\",\"name\":\"Pont du Suro\u00eet\",\"url\":\"https:\\\/\\\/lepont.com\\\/en\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/lepont.com\\\/wp-content\\\/uploads\\\/2021\\\/06\\\/logo-le-pont-suroit.svg\",\"contentUrl\":\"https:\\\/\\\/lepont.com\\\/wp-content\\\/uploads\\\/2021\\\/06\\\/logo-le-pont-suroit.svg\",\"width\":392,\"height\":64,\"caption\":\"Pont du Suro\u00eet\"},\"image\":{\"@id\":\"https:\\\/\\\/lepont.com\\\/en\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet","description":"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/","og_locale":"en_US","og_type":"article","og_title":"Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet","og_description":"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.","og_url":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/","og_site_name":"Pont du Suro\u00eet","article_modified_time":"2021-10-13T14:13:45+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/","url":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/","name":"Fellow Counsellors Having People with Mental Illness to Refer - Pont du Suro\u00eet","isPartOf":{"@id":"https:\/\/lepont.com\/en\/#website"},"datePublished":"2021-09-20T13:25:05+00:00","dateModified":"2021-10-13T14:13:45+00:00","description":"Are you a counsellor having a person with a mental illness to refer? Just fill in and submit a form.","breadcrumb":{"@id":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/lepont.com\/en\/intervenant-du-milieu\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/lepont.com\/en\/intervenant-du-milieu\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"https:\/\/lepont.com\/en\/"},{"@type":"ListItem","position":2,"name":"Fellow Counsellors"}]},{"@type":"WebSite","@id":"https:\/\/lepont.com\/en\/#website","url":"https:\/\/lepont.com\/en\/","name":"Pont du Suro\u00eet","description":"Centre d&#039;intervention psychosociale","publisher":{"@id":"https:\/\/lepont.com\/en\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/lepont.com\/en\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/lepont.com\/en\/#organization","name":"Pont du Suro\u00eet","url":"https:\/\/lepont.com\/en\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/lepont.com\/en\/#\/schema\/logo\/image\/","url":"https:\/\/lepont.com\/wp-content\/uploads\/2021\/06\/logo-le-pont-suroit.svg","contentUrl":"https:\/\/lepont.com\/wp-content\/uploads\/2021\/06\/logo-le-pont-suroit.svg","width":392,"height":64,"caption":"Pont du Suro\u00eet"},"image":{"@id":"https:\/\/lepont.com\/en\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/pages\/3932","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/comments?post=3932"}],"version-history":[{"count":0,"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/pages\/3932\/revisions"}],"wp:attachment":[{"href":"https:\/\/lepont.com\/en\/wp-json\/wp\/v2\/media?parent=3932"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}