{"0":{"button":{"imageUrl":"","text":"Envoyer","type":"text"},"description":"T\u00e9l\u00e9consultation gratuite et confidentielle","descriptionPlacement":"above","fields":[{"type":"date","id":255,"label":"RDV Date","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"dateType":"datepicker","calendarIconType":"none","formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"doff_rdv_date","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","calendarIconUrl":"","dateFormat":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"time","id":256,"label":"RDV Heure","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":[{"id":"256.1","label":"HH","name":""},{"id":"256.2","label":"MM","name":""},{"id":"256.3","label":"AM\/PM","name":""}],"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"doff_rdv_time","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","timeFormat":"24","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":186,"label":"status","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"status","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":187,"label":"country","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"country","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":188,"label":"countryCode","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"countryCode","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":189,"label":"region","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"region","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":190,"label":"regionName","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"regionName","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":191,"label":"city","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"city","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":192,"label":"zip","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"zip","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":193,"label":"lat","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"lat","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":194,"label":"lon","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"lon","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":195,"label":"timezone","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"timezone","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":196,"label":"isp","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"isp","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":197,"label":"org","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"org","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":198,"label":"as","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"as","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"text","id":199,"label":"query","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"query","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"html","adminLabel":"","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":"","conditionalLogic":"","content":"[doff_checkup_welcome_message sender=doff_sender_user_id patient_email=doff_patient_email]","cssClass":"doff_webconsult_intro","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":true,"enableCalculation":"","errorMessage":"","formId":8,"id":1,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":null,"isRequired":false,"label":"Comprendre et soulager vos probl\u00e8mes","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":165,"label":"Patient reference","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"inputName":"doff_patient_ref","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":182,"label":"profile","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"inputName":"doff_profile_ref","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":183,"label":"diagnosis","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"inputName":"doff_diagnosis_ref","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":283,"label":"Algo Evaluation validity","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_comma","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"administrative","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","enableCalculation":false,"rangeMin":"-5","rangeMax":"10","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":227,"label":"Practitioner Diagnosis reference","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"inputName":"doff_diagnosis_ref","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":228,"label":"Practitioner Validation Match","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"inputName":"doff_diagnosis_ref","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"list","id":297,"label":"clinical situation","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"administrative","noDuplicates":false,"defaultValue":"","choices":[{"text":"algo_category","value":"algo_category","isSelected":false,"price":""},{"text":"algo_eval_validity","value":"algo_eval_validity","isSelected":false,"price":""},{"text":"algo_profile_ref","value":"algo_profile_ref","isSelected":false,"price":""},{"text":"algo_diagnosis_ref","value":"algo_diagnosis_ref","isSelected":false,"price":""},{"text":"algo_displayed_result","value":"algo_displayed_result","isSelected":false,"price":""},{"text":"practitioner_diagnosis_ref","value":"practitioner_diagnosis_ref","isSelected":false,"price":""},{"text":"practitioner_validation","value":"practitioner_validation","isSelected":false,"price":""},{"text":"extra_diagnosis_ref","value":"extra_diagnosis_ref","isSelected":false,"price":""}],"conditionalLogic":"","maxRows":0,"productField":"","itsg_list_field_drop_down":"","itsg_list_field_drop_down_enhanced":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableColumns":true,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":161,"label":"Restriction praticien","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"inputName":"doff_restriction","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":333,"label":"Template type","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"inputName":"doff_template_type","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":67,"label":"Sender email","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","inputName":"doff_initial_form_sender_email","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":282,"label":"source lead id","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","inputName":"doff_lead_id","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"-1","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"email","id":277,"label":"Sender E-mail","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"doff_initial_form_sender_email","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","emailConfirmEnabled":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":242,"label":"Sender WP User ID","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","inputName":"doff_sender_user_id","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":295,"label":"Sender Office ID","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","inputName":"doff_sender_office_id","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":221,"label":"source network","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","inputName":"doff_network","formId":8,"description":"","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","adminLabel":"","allowsPrepopulate":true,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"<i class=\"fa fa-female\" aria-hidden=\"true\"><\/i>&nbsp;Une femme","value":"f"},{"isSelected":false,"price":"","text":"<i class=\"fa fa-male\" aria-hidden=\"true\"><\/i>&nbsp;Un homme","value":"m"}],"conditionalLogic":"","cssClass":"doff_sex gf_left_half doff_no_clear","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","enableCalculation":"","errorMessage":"","formId":8,"id":2,"inputMask":false,"inputMaskValue":"","inputName":"doff_sex","inputType":"","inputs":null,"isRequired":true,"label":"Vous \u00eates","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"date","adminLabel":"","allowsPrepopulate":true,"calculationFormula":"","calculationRounding":"","calendarIconType":"none","calendarIconUrl":"","choices":"","conditionalLogic":"","cssClass":"doff_birthday gf_right_half doff_no_clear","dateFormat":"dmy","dateType":"datedropdown","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","enableCalculation":"","errorMessage":"","formId":8,"id":3,"inputMask":false,"inputMaskValue":"","inputName":"doff_birthdate","inputType":"","inputs":[{"id":"3.1","label":"Mois","name":"","placeholder":"Mois","defaultValue":""},{"id":"3.2","label":"Jour","name":"","placeholder":"Jour","defaultValue":""},{"id":"3.3","label":"Ann\u00e9e","name":"","placeholder":"Ann\u00e9e","defaultValue":""}],"isRequired":true,"label":"Date de naissance","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":154,"label":"Age","adminLabel":"","isRequired":false,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","labelPlacement":"","descriptionPlacement":"below","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":false,"disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"rangeMin":"1","rangeMax":"120","cssClass":"readonly doff_no_clear","formId":8,"description":"ans","inputType":"","inputName":"doff_age","noDuplicates":false,"defaultValue":"46","choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":245,"label":"Votre souhaitez:","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Effectuer un <span class=\"doff_text_focus\">bilan ou un contr\u00f4le<\/span> de votre sant\u00e9 bucco-dentaire","value":"checkup","isSelected":false,"price":""},{"text":"R\u00e9pondre \u00e0 un <span class=\"doff_text_focus\">probl\u00e8me bucco-dentaire particulier<\/span>","value":"categories_stream","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"doff_type_of_demand","visibility":"hidden","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","adminLabel":"","allowsPrepopulate":true,"calculationFormula":"","calculationRounding":"","choices":[{"text":"<div data-content=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" id=\"cat_overlay\"><img id=\"teeth_cat_svg\" title=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" alt=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dents.svg\"\/><\/div><h3 class=\"main_cat_title\">Dents<\/h3><h3 class=\"main_cat_title\">(adultes et enfants)<\/h3>","value":"teeth","isSelected":false,"price":""},{"text":"<div data-content=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" id=\"cat_overlay\"><img id=\"gingiva_cat_svg\" title=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" alt=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/gencive.svg\"\/><\/div><h3 class=\"main_cat_title\">Gencives<\/h3><h3 class=\"main_cat_title\">Dents qui bougent<\/h3>","value":"perio","isSelected":false,"price":""},{"text":"<div data-content=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" id=\"cat_overlay\"><img title=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" alt=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/protheses.svg\"\/><\/div><h3 class=\"main_cat_title\">Proth\u00e8ses \/ Implants<\/h3><h3 class=\"main_cat_title\">Remplacer des dents<\/h3>","value":"replacement","isSelected":false,"price":""},{"text":"<div data-content=\"Esth\u00e9tique du sourire\" id=\"cat_overlay\"><img title=\"Esth\u00e9tique du sourire\" alt=\"Esth\u00e9tique du sourire\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/esthetique.svg\"\/><\/div><h3 class=\"main_cat_title\">Esth\u00e9tique du sourire<\/h3><h3 class=\"main_cat_title\">et sant\u00e9<\/h3>","value":"aesthetic","isSelected":false,"price":""},{"text":"<div data-content=\"Articulation et muscles : bruits, douleurs, blocages\" id=\"cat_overlay\"><img title=\"Articulation et muscles : bruits, douleurs, blocages\" alt=\"Articulation et muscles : bruits, douleurs, blocages\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/occluso.svg\"\/><\/div><h3 class=\"main_cat_title\">Articulation<\/h3><h3 class=\"main_cat_title\"> et muscles<\/h3>","value":"occluso","isSelected":false,"price":""},{"text":"<div data-content=\"Langue, joues, l\u00e8vres, palais... : douleurs et l\u00e9sions\" id=\"cat_overlay\"><img title=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" alt=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dermato.svg\"\/><\/div><h3 class=\"main_cat_title\">Langue, joues, l\u00e8vres, palais...<\/h3>","value":"dermato","isSelected":false,"price":""}],"conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"245","operator":"is","value":"categories_stream"},{"fieldId":"246","operator":"is","value":"towards_main"}]},"cssClass":"gf_list_6col main_categories","defaultValue":"","description":"Si votre demande concerne plusieurs cat\u00e9gories illustr\u00e9es ci-dessous, merci de recommencer le questionnaire autant de fois que n\u00e9cessaire.","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","errorMessage":"","formId":8,"id":17,"inputMask":false,"inputMaskValue":"","inputName":"doff_general_category","inputType":"","inputs":null,"isRequired":false,"label":"Parmi les 6 images ci-dessous, choisissez et cliquez sur celle qui correspond \u00e0 votre demande","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":299,"label":"Parmi les 7 images ci-dessous, choisissez et cliquez sur celle(s) qui correspond(ent) \u00e0 votre(vos) demande(s)","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"<div data-content=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" id=\"cat_overlay\"><img id=\"teeth_cat_svg\" title=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" alt=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dents.svg\"\/><\/div><h3 class=\"main_cat_title\">Dents<\/h3><h3 class=\"main_cat_title\">(adultes et enfants)<\/h3>","value":"teeth","isSelected":false,"price":""},{"text":"<div data-content=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" id=\"cat_overlay\"><img id=\"gingiva_cat_svg\" title=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" alt=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/gencive.svg\"\/><\/div><h3 class=\"main_cat_title\">Gencives<\/h3><h3 class=\"main_cat_title\">Dents qui bougent<\/h3>","value":"perio","isSelected":false,"price":""},{"text":"<div data-content=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" id=\"cat_overlay\"><img title=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" alt=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/protheses.svg\"\/><\/div><h3 class=\"main_cat_title\">Proth\u00e8ses \/ Implants<\/h3><h3 class=\"main_cat_title\">Remplacer des dents<\/h3>","value":"replacement","isSelected":false,"price":""},{"text":"<div data-content=\"Esth\u00e9tique du sourire\" id=\"cat_overlay\"><img title=\"Esth\u00e9tique du sourire\" alt=\"Esth\u00e9tique du sourire\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/esthetique.svg\"\/><\/div><h3 class=\"main_cat_title\">Esth\u00e9tique du sourire<\/h3><h3 class=\"main_cat_title\">et sant\u00e9<\/h3>","value":"aesthetic","isSelected":false,"price":""},{"text":"<div data-content=\"Articulation et muscles : bruits, douleurs, blocages\" id=\"cat_overlay\"><img title=\"Articulation et muscles : bruits, douleurs, blocages\" alt=\"Articulation et muscles : bruits, douleurs, blocages\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/occluso.svg\"\/><\/div><h3 class=\"main_cat_title\">Articulation<\/h3><h3 class=\"main_cat_title\"> et muscles<\/h3>","value":"occluso","isSelected":false,"price":""},{"text":"<div data-content=\"Langue, joues, l\u00e8vres, palais... : douleurs et l\u00e9sions\" id=\"cat_overlay\"><img title=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" alt=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dermato.svg\"\/><\/div><h3 class=\"main_cat_title\">Langue, joues, l\u00e8vres, palais...<\/h3>","value":"dermato","isSelected":false,"price":""},{"text":"<div data-content=\"Bilan et Contr\u00f4les\" id=\"cat_overlay\"><img title=\"Bilan et Contr\u00f4les\" alt=\"Bilan et Contr\u00f4les\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/controles_optim.svg\"\/><\/div><h3 class=\"main_cat_title\">Bilan et Contr\u00f4les<\/h3>","value":"checkup","isSelected":false,"price":""}],"inputs":[{"id":"299.1","label":"<div data-content=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" id=\"cat_overlay\"><img id=\"teeth_cat_svg\" title=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" alt=\"Dents (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dents.svg\"\/><\/div><h3 class=\"main_cat_title\">Dents<\/h3><h3 class=\"main_cat_title\">(adultes et enfants)<\/h3>","name":""},{"id":"299.2","label":"<div data-content=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" id=\"cat_overlay\"><img id=\"gingiva_cat_svg\" title=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" alt=\"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/gencive.svg\"\/><\/div><h3 class=\"main_cat_title\">Gencives<\/h3><h3 class=\"main_cat_title\">Dents qui bougent<\/h3>","name":""},{"id":"299.3","label":"<div data-content=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" id=\"cat_overlay\"><img title=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" alt=\"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/protheses.svg\"\/><\/div><h3 class=\"main_cat_title\">Proth\u00e8ses \/ Implants<\/h3><h3 class=\"main_cat_title\">Remplacer des dents<\/h3>","name":""},{"id":"299.4","label":"<div data-content=\"Esth\u00e9tique du sourire\" id=\"cat_overlay\"><img title=\"Esth\u00e9tique du sourire\" alt=\"Esth\u00e9tique du sourire\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/esthetique.svg\"\/><\/div><h3 class=\"main_cat_title\">Esth\u00e9tique du sourire<\/h3><h3 class=\"main_cat_title\">et sant\u00e9<\/h3>","name":""},{"id":"299.5","label":"<div data-content=\"Articulation et muscles : bruits, douleurs, blocages\" id=\"cat_overlay\"><img title=\"Articulation et muscles : bruits, douleurs, blocages\" alt=\"Articulation et muscles : bruits, douleurs, blocages\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/occluso.svg\"\/><\/div><h3 class=\"main_cat_title\">Articulation<\/h3><h3 class=\"main_cat_title\"> et muscles<\/h3>","name":""},{"id":"299.6","label":"<div data-content=\"Langue, joues, l\u00e8vres, palais... : douleurs et l\u00e9sions\" id=\"cat_overlay\"><img title=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" alt=\"Langue, joues, l\u00e8vres, palais...  : douleurs et l\u00e9sions\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/dermato.svg\"\/><\/div><h3 class=\"main_cat_title\">Langue, joues, l\u00e8vres, palais...<\/h3>","name":""},{"id":"299.7","label":"<div data-content=\"Bilan et Contr\u00f4les\" id=\"cat_overlay\"><img title=\"Bilan et Contr\u00f4les\" alt=\"Bilan et Contr\u00f4les\" class=\"category_img\" src=\"https:\/\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/controles_optim.svg\"\/><\/div><h3 class=\"main_cat_title\">Bilan et Contr\u00f4les<\/h3>","name":""}],"formId":8,"description":"Si votre demande concerne plusieurs cat\u00e9gories illustr\u00e9es ci-dessous, merci de selectionner toutes les images vous concernant.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_7col main_categories","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":155,"label":"age inf\u00e9rieur \u00e0 17 ans","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"content":"[alert type=\"warning\" close=\"false\" heading=\"Attention\"] Les proth\u00e8ses sont r\u00e9serv\u00e9es aux adultes et vous avez 17 ans ou moins. Merci de choisir une autre cat\u00e9gorie. [\/alert]","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":"<","value":"18"},{"fieldId":"17","operator":"is","value":"replacement"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","id":173,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":"","conditionalLogic":{"actionType":"hide","logicType":"all","rules":[{"fieldId":"17","operator":"is","value":"replacement"},{"fieldId":"154","operator":"<","value":"18"}]}},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"299","operator":"is","value":"teeth"},{"fieldId":"299","operator":"is","value":"perio"},{"fieldId":"299","operator":"is","value":"replacement"},{"fieldId":"299","operator":"is","value":"aesthetic"},{"fieldId":"299","operator":"is","value":"occluso"},{"fieldId":"299","operator":"is","value":"dermato"},{"fieldId":"299","operator":"is","value":"checkup"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":300,"label":"Bilan \/ Contr\u00f4le","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"299","operator":"is","value":"checkup"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":324,"label":"Merci de pr\u00e9ciser","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"choices":[{"text":"Ma bouche est globalement en tr\u00e8s bon \u00e9tat et je ne souhaite effectivement qu\u2019un simple contr\u00f4le de la situation","value":"checkup_control","isSelected":false,"price":""},{"text":"Je n\u2019ai pas de probl\u00e8mes importants mais j\u2019aimerais bien que le dentiste fasse un tour d\u2019horizon, et me donne des conseils.","value":"checkup_counsel","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":246,"label":"Ma bouche est globalement en tr\u00e8s bon \u00e9tat et je ne souhaite effectivement qu\u2019un simple contr\u00f4le de la situation","adminLabel":"checkup_good_health","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Vous avez l\u2019habitude de faire des <span class=\"doff_text_focus\">contr\u00f4les r\u00e9guliers<\/span> de votre bouche","value":"checkup_regular","isSelected":false,"price":""},{"text":"Vous suivez un <span class=\"doff_text_focus\">programme de maintenance<\/span>","value":"checkup_maintenance","isSelected":false,"price":""},{"text":"Vous devez effectuer un <span class=\"doff_text_focus\">bilan \u00e0 la demande d\u2019un organisme ou d'un professionnel de sant\u00e9<\/span>","value":"checkup_tier","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"324","operator":"is","value":"checkup_control"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":325,"label":"Je n\u2019ai pas de probl\u00e8mes importants mais j\u2019aimerais bien que le dentiste fasse un tour d\u2019horizon, et me donne des conseils.","adminLabel":"checkup_and_counsel","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je m\u2019interroge sur un certain nombre de points","value":"checkup_wondering","isSelected":false,"price":""},{"text":"Vous avez mauvaise haleine","value":"checkup_halitosis","isSelected":false,"price":""},{"text":"Vous ronflez la nuit et vous avez un mauvais sommeil","value":"sleep_apnea","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"324","operator":"is","value":"checkup_counsel"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":305,"label":"Vous suivez un programme de maintenance","adminLabel":"checkup_maintenance","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Vous suivez un programme de <span class=\"doff_text_focus\">maintenance parodontale<\/span>","value":"perio_maintenance","isSelected":false,"price":""},{"text":"Vous suivez un programme de <span class=\"doff_text_focus\">maintenance implantaire<\/span>","value":"implanto_maintenance","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"246","operator":"is","value":"checkup_maintenance"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":306,"label":"Vous devez effectuer un bilan \u00e0 la demande d\u2019un organisme social ou d'un professionnel de sant\u00e9","adminLabel":"checkup_from_tier","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Vous devez effectuer un <span class=\"doff_text_focus\">bilan \u00e0 la demande d\u2019un organisme social<\/span> ou d\u2019une assurance","value":"checkup_insurrance","isSelected":false,"price":""},{"text":"Vous devez effectuer un <span class=\"doff_text_focus\">bilan \u00e0 la demande d\u2019un m\u00e9decin ou d\u2019un professionnel de sant\u00e9<\/span>","value":"checkup_doctor","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"246","operator":"is","value":"checkup_tier"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":307,"label":"Vous avez mauvaise haleine","adminLabel":"checkup_halitosis","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Vous avez des dents ou des gencives ab\u00eem\u00e9es","value":"checkup_halitosis_bad_state","isSelected":false,"price":""},{"text":"Vos dents et vos gencives sont r\u00e9guli\u00e8rement suivies et en bon \u00e9tat","value":"checkup_halitosis_other","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"325","operator":"is","value":"checkup_halitosis"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":326,"label":"Je m\u2019interroge sur un certain nombre de points","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"325","operator":"is","value":"checkup_wondering"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":327,"label":"Vos gencives saignent elles","adminLabel":"checkup_perio_blood","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"0","isSelected":false,"price":""},{"text":"Oui, parfois","value":"1","isSelected":false,"price":""},{"text":"Oui, assez souvent","value":"2","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":328,"label":"Avez vous une ou plusieurs dents qui de temps en temps vous inqui\u00e8tent ?","adminLabel":"checkup_warning_tooth","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"0","isSelected":false,"price":""},{"text":"Oui","value":"1","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":329,"label":"Avez vous un ou plusieurs implants ?","adminLabel":"checkup_implants","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"0","isSelected":false,"price":""},{"text":"Oui et je n\u2019ai aucun souci.","value":"1","isSelected":false,"price":""},{"text":"Oui et j\u2019aimerais quelques informations","value":"2","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":330,"label":"Avez vous des proth\u00e8ses (couronnes, bridges ou appareil amovible) ?","adminLabel":"checkup_prosthesis","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"0","isSelected":false,"price":""},{"text":"Oui et je n\u2019ai aucun souci.","value":"1","isSelected":false,"price":""},{"text":"Oui et j\u2019aimerais quelques informations","value":"2","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":141,"label":"Dents  (adultes et enfants) : abim\u00e9es, douloureuses, ou apr\u00e8s extraction","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"299","operator":"is","value":"teeth"},{"fieldId":"328","operator":"is","value":"1"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":59,"label":"Parmi les 11 profils ci-dessous, choisissez celui qui se rapproche le plus de votre situation","adminLabel":"teeth","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"<span class=\"doff_text_focus\">Je redoute d\u2019avoir une dent qui s\u2019ab\u00eeme<\/span>, ou, j'ai une obturation qui s'est cass\u00e9e ou qui est partie. Je ne souffre pas.","value":"teeth_alert_signs","isSelected":false,"price":""},{"text":"Quelque chose de <span class=\"doff_text_focus\">coinc\u00e9 entre 2 dents<\/span> provoque des douleurs","value":"perio_septum","isSelected":false,"price":""},{"text":"J\u2019ai mal sur une <span class=\"doff_text_focus\">dent qui semble intacte<\/span> (pas de trou, d\u2019usure ou de fracture), et pourtant le froid ou le sucre y d\u00e9clenchent une douleur.","value":"teeth_healthy_painful_decay_beg_or_fissure","isSelected":false,"price":""},{"text":"J\u2019ai mal sur une <span class=\"doff_text_focus\">dent qui est ab\u00eem\u00e9e<\/span>, cari\u00e9e ou d\u00e9j\u00e0 soign\u00e9e. La douleur appara\u00eet avec le froid, et\/ou le chaud, et\/ou en mangeant dessus.","value":"teeth_decay_choice","isSelected":false,"price":""},{"text":"<span class=\"doff_text_focus\">Un enfant se plaint<\/span> de dents de lait douloureuses","value":"teeth_milk_painful","isSelected":false,"price":""},{"text":"J\u2019ai des <span class=\"doff_text_focus\">dents us\u00e9es ou plates<\/span> ; certaines peuvent \u00eatre douloureuses.","value":"teeth_bruxomania","isSelected":false,"price":""},{"text":"Des <span class=\"doff_text_focus\">encoches au ras de la gencive<\/span> sont visibles sur plusieurs dents","value":"teeth_mylolyse","isSelected":false,"price":""},{"text":"J\u2019ai une ou plusieurs <span class=\"doff_text_focus\">dents fractur\u00e9es<\/span>","value":"teeth_broken","isSelected":false,"price":""},{"text":"Une <span class=\"doff_text_focus\">dent de sagesse<\/span> qui pousse me fait mal (derni\u00e8re dent au fond)","value":"perio_wisdom_teeth","isSelected":false,"price":""},{"text":"<span class=\"doff_text_focus\">L\u2019extraction de dents<\/span> est \u00e0 l\u2019origine des douleurs","value":"teeth_extraction_pain","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"\/*gf_list_2col gl_list_2col_no_wrap*\/","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":142,"label":"Gencives : douleur, gonflement, saignement, dents d\u00e9chauss\u00e9es ou qui bougent","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"299","operator":"is","value":"perio"},{"fieldId":"327","operator":"is","value":"2"},{"fieldId":"307","operator":"is","value":"checkup_halitosis_bad_state"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":24,"label":"Parmi les 8 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"perio_sub_category","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je ne souffre pas vraiment mais je m\u2019interroge sur <span class=\"doff_text_focus\">la sant\u00e9 de mes gencives<\/span>","value":"perio_alert_signs","isSelected":false,"price":""},{"text":"La gencive est en assez bonne sant\u00e9, mais il y a une <span class=\"doff_text_focus\">petite rougeur ou gonflement<\/span> autour de certaines dents ; elles ne bougent pas et ne sont pas d\u00e9chauss\u00e9es.","value":"perio_gingivitis","isSelected":false,"price":""},{"text":"Ma <span class=\"doff_text_focus\">gencive est enflamm\u00e9e<\/span> (rougeur, ou gonflement ou saignement ou douleur). Certaines <span class=\"doff_text_focus\">dents sont d\u00e9chauss\u00e9es<\/span> ou mobiles.","value":"perio_perio_30","isSelected":false,"price":""},{"text":"Vous n\u2019arrivez pas \u00e0<span class=\"doff_text_focus\"> soigner compl\u00e8tement<\/span> une maladie de gencives","value":"perio_already_sick","isSelected":false,"price":""},{"text":"Il y a une <span class=\"doff_text_focus\">douleur forte<\/span> et un gonflement autour d\u2019une dent pr\u00e9cise","value":"perio_abscess_to_confirm","isSelected":false,"price":""},{"text":"Le probl\u00e8me a d\u00e9but\u00e9 avec la <span class=\"doff_text_focus\">grossesse<\/span>","value":"perio_gravidic","isSelected":false,"price":""},{"text":"La gencive est douloureuse \u00e0 cause de quelque chose <span class=\"doff_text_focus\">coinc\u00e9 entre 2 dents<\/span>.","value":"perio_septum","isSelected":false,"price":""},{"text":"Dans la r\u00e9gion de la <span class=\"doff_text_focus\">dent de sagesse<\/span> la gencive est gonfl\u00e9e et\/ou douloureuse","value":"perio_wisdom_teeth","isSelected":false,"price":""},{"text":"La gencive est gonfl\u00e9e autour d\u2019une dent qui est en partie cass\u00e9e ou qui pr\u00e9sente <span class=\"doff_text_focus\">un morceau qui bouge<\/span>","value":"perio_fracture","isSelected":false,"price":""},{"text":"Il y a des <span class=\"doff_text_focus\">taches ou des anomalies<\/span> sur l\u2019int\u00e9rieur des joues, sur les l\u00e8vres, la langue ou le palais","value":"perio_dermato","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"conditionalLogic":"","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":308,"label":"Douleur et gonflement autour d'une dent pr\u00e9cise","adminLabel":"perio_abscess_to_confirm","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"J'observe aussi autour d'autres dents des atteintes de gencives : rougeurs, saignements, d\u00e9chaussements, espace entre les dents","value":"perio_perio_30","isSelected":false,"price":""},{"text":"Il n'y a que cette dent atteinte, et le reste de la gencive est en parfaite sant\u00e9","value":"perio_abscess_sure","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","enableChoiceValue":true,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"24","operator":"is","value":"perio_abscess_to_confirm"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":79,"label":"Probl\u00e8me dermatologique?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"24","operator":"is","value":"perio_dermato"}]},"content":"[doff-change-category-branch go_to=\"dermato\"]","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":139,"label":"Proth\u00e8ses \/ Implants : remplacer des dents, entretenir ou changer vos proth\u00e8ses","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"299","operator":"is","value":"replacement"},{"fieldId":"329","operator":"is","value":"2"},{"fieldId":"330","operator":"is","value":"2"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":136,"label":"Pr\u00e9cisez votre demande","adminLabel":"replacement","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je souhaite <span class=\"doff_text_focus\">remplacer des dents manquantes<\/span> ou ou <span class=\"doff_text_focus\">remplacer mes proth\u00e8ses actuelles<\/span>","value":"replacement_svg","isSelected":false,"price":""},{"text":"Je souhaite des informations sur <span class=\"doff_text_focus\">l'entretien des proth\u00e8ses et\/ou des implants<\/span>","value":"replacement_maintenance","isSelected":false,"price":""},{"text":"J'ai de <span class=\"doff_text_focus\">vrais soucis<\/span> avec mes proth\u00e8ses et\/ou mes implants","value":"replacement_pb","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":">","value":"17"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":331,"label":"Pas pour les jeunes","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":"<","value":"18"}]},"content":"[alert type=\"warn\"]Les proth\u00e8ses ne sont pas recommand\u00e9es pour des jeunes personnes. Merci de revenir en arri\u00e8re et de faire un autre choix[\/alert]","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":145,"label":"Esth\u00e9tique du sourire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"299","operator":"is","value":"aesthetic"}]},"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":35,"label":"Parmi les 6 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"aesthetic","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je <span class=\"doff_text_focus\">m\u2019interroge sur l\u2019esth\u00e9tique de mon sourire<\/span> et je souhaite conna\u00eetre les diff\u00e9rents moyens de l\u2019am\u00e9liorer","value":"aesthetic_info","isSelected":false,"price":""},{"text":"Je souhaite <span class=\"doff_text_focus\">modifier des dents en bon \u00e9tat<\/span>, mais qui ne me satisfont plus (couleur, forme, place)","value":"aesthetic_minimal","isSelected":false,"price":""},{"text":"Des dents d\u00e9j\u00e0 soign\u00e9es, ou des proth\u00e8ses, ou des dents absentes posent un <span class=\"doff_text_focus\">probl\u00e8me esth\u00e9tique<\/span>","value":"aesthetic_restauration","isSelected":false,"price":""},{"text":"<span class=\"doff_text_focus\">L\u2019esth\u00e9tique de mes gencives<\/span> (forme, couleur) ne me satisfait plus","value":"aesthetic_gingiva","isSelected":false,"price":""},{"text":"Des <span class=\"doff_text_focus\">dents sont mal rang\u00e9es<\/span>. Je souhaite am\u00e9liorer la situation","value":"aesthetic_odf","isSelected":false,"price":""},{"text":"Une ou des interventions, proth\u00e9tique et\/ou de chirurgie plastique, et\/ou de dermatologie et\/ou d\u2019orthodontie n\u2019ont <span class=\"doff_text_focus\">pas r\u00e9pondu \u00e0 mon attente<\/span>.","value":"aesthetic_not_satisfied","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","enableOtherChoice":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":263,"label":"Que souhaiteriez-vous modifier","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"La forme","value":"La forme","isSelected":false,"price":""},{"text":"La couleur","value":"La couleur","isSelected":false,"price":""},{"text":"La place","value":"La place","isSelected":false,"price":""}],"inputs":[{"id":"263.1","label":"La forme","name":""},{"id":"263.2","label":"La couleur","name":""},{"id":"263.3","label":"La place","name":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_minimal"}]},"productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":251,"label":"Pr\u00e9ciser","adminLabel":"aesthetic_not_satisfied","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je m\u2019interroge sur les raisons de cet \u00e9chec","value":"aesthetic_wondering_failure","isSelected":false,"price":""},{"text":"Les praticiens que j\u2019ai consult\u00e9s n\u2019\u00e9coutent pas ou ne respectent pas ce que je leur demande","value":"aesthetic_dysmorphophobia","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_not_satisfied"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":143,"label":"Blocages ou douleurs de l'articulation ou des muscles de la m\u00e2choire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"299","operator":"is","value":"occluso"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","adminLabel":"occluso","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"L\u2019articulation de la m\u00e2choire <span class=\"doff_text_focus\">craque (ou a craqu\u00e9), ou se bloque<\/span> quand j\u2019ouvre ou je ferme la bouche","value":"occluso_articular"},{"isSelected":false,"price":"","text":"Je souffre de la m\u00e2choire, de la t\u00eate, ou du cou. Il n\u2019y a jamais eu de bruit dans l\u2019articulation. Les <span class=\"doff_text_focus\">mouvements de ma m\u00e2choire sont limit\u00e9s<\/span> ou impossibles.","value":"occluso_muscular"},{"isSelected":false,"price":"","text":"<span class=\"doff_text_focus\">Je grince des dents la nuit<\/span> et j\u2019ai les dents tr\u00e8s us\u00e9es.","value":"occluso_bruxomania"},{"isSelected":false,"price":"","text":"Des probl\u00e8mes dentaires mal soign\u00e9s m\u2019ont <span class=\"doff_text_focus\">compl\u00e8tement d\u00e9s\u00e9quilibr\u00e9(e)<\/span>. Personne ne soulage vraiment mes douleurs","value":"occluso_psychiatric"},{"text":"<span class=\"doff_text_focus\">Ma m\u00e2choire se bloque en ouverture<\/span> et je ne peux plus refermer","value":"occluso_mandibular_luxation","isSelected":false,"price":""}],"conditionalLogic":"","cssClass":"","defaultValue":"","description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","enableChoiceValue":true,"errorMessage":"","formId":8,"id":19,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":null,"isRequired":true,"label":"Parmi les 5 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":144,"label":"Langue, joues, l\u00e8vres, palais... : douleurs et l\u00e9sions","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"299","operator":"is","value":"dermato"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":40,"label":"Parmi les profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"dermato","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"<span class=\"doff_text_focus\">Vous vous \u00eates bless\u00e9(e) ou br\u00fbl\u00e9(e).<\/span> Il y a une marque (qui ne saigne plus) sur la gencive, l\u2019int\u00e9rieur des joues, sur la langue ou \u00e0 l\u2019int\u00e9rieur des l\u00e8vres.","value":"hurt","isSelected":false,"price":""},{"text":"Vous avez des <span class=\"doff_text_focus\">t\u00e2ches claires bien d\u00e9limit\u00e9es<\/span>, arrondies et en creux, douloureuses, sur les joues, \u00e0 l\u2019int\u00e9rieur des l\u00e8vres ou sous la langue.","value":"aphte","isSelected":false,"price":""},{"text":"Vous avez <span class=\"doff_text_focus\">au bord de la gencive ou entre deux dents<\/span> une sorte de petite boursouflure isol\u00e9e, lisse et non douloureuse.","value":"epulis","isSelected":false,"price":""},{"text":"Vous avez <span class=\"doff_text_focus\">\u00e0 l\u2019int\u00e9rieur des joues ou des l\u00e8vres<\/span>, ou au bord de la langue. une petite boule charnue, lisse, souple et non douloureuse.","value":"diapneusie_algo","isSelected":false,"price":""},{"text":"Vous avez d\u00e8s le r\u00e9veil <span class=\"doff_text_focus\">une sensation de br\u00fblure<\/span> de la langue ou de l\u2019int\u00e9rieur de la bouche mais vous n\u2019y voyez pas vraiment de blessure ou de l\u00e9sion ou de t\u00e2che particuli\u00e8re.","value":"stomatodynies_algo","isSelected":false,"price":""},{"text":"Vous avez <span class=\"doff_text_focus\">des zones blanches et\/ou rouges<\/span> \u00e0 l\u2019int\u00e9rieur des joues, sur les gencives, les l\u00e8vres, la langue ou au palais.","value":"dermato_lichen_algo","isSelected":false,"price":""},{"text":"Vous avez <span class=\"doff_text_focus\">un bouton de fi\u00e8vre sur la l\u00e8vre, ou des v\u00e9sicules ou bulles<\/span> sur les joues ou le palais ou les gencives","value":"herpes_algo","isSelected":false,"price":""},{"text":"Vous avez des v\u00e9sicules ou <span class=\"doff_text_focus\">des petites bulles sur un seul cot\u00e9 de la bouche<\/span> et sur la peau du visage du m\u00eame cot\u00e9","value":"zona_algo","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"conditionalLogic":"","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":92,"label":"Probl\u00e8me parodontologique?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"dermato_paro"}]},"content":"[doff-change-category-branch go_to=\"perio\"]","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","id":174,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":"","conditionalLogic":{"actionType":"hide","logicType":"any","rules":[{"fieldId":"40","operator":"is","value":"dermato_paro"},{"fieldId":"24","operator":"is","value":"perio_dermato"}]}},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"59","operator":"is","value":"teeth_decay_choice"},{"fieldId":"59","operator":"is","value":"teeth_milk_painful"},{"fieldId":"59","operator":"is","value":"teeth_bruxomania"},{"fieldId":"59","operator":"is","value":"teeth_broken"},{"fieldId":"59","operator":"is","value":"teeth_extraction_pain"},{"fieldId":"24","operator":"is","value":"perio_perio_30"},{"fieldId":"24","operator":"is","value":"perio_already_sick"},{"fieldId":"24","operator":"is","value":"perio_abscess_to_confirm"},{"fieldId":"35","operator":"is","value":"aesthetic_odf"},{"fieldId":"35","operator":"is","value":"aesthetic_info"},{"fieldId":"35","operator":"is","value":"aesthetic_gingiva"},{"fieldId":"19","operator":"is","value":"occluso_articular"},{"fieldId":"19","operator":"is","value":"occluso_muscular"},{"fieldId":"299","operator":"is","value":"replacement"},{"fieldId":"329","operator":"is","value":"2"},{"fieldId":"330","operator":"is","value":"2"},{"fieldId":"40","operator":"is","value":"diapneusie_algo"},{"fieldId":"40","operator":"is","value":"stomatodynies_algo"},{"fieldId":"40","operator":"is","value":"dermato_lichen_algo"},{"fieldId":"40","operator":"is","value":"herpes_algo"},{"fieldId":"40","operator":"is","value":"zona_algo"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":147,"label":"Remplacer des dents manquantes : proth\u00e8ses\/implants","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_svg"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":252,"label":"Pouvez-vous remplir le sch\u00e9ma dentaire ci-dessous?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"y","isSelected":true,"price":""},{"text":"Non","value":"n","isSelected":false,"price":""}],"formId":8,"description":"Si vous n'y parvenez pas, merci de r\u00e9pondre \"Non\"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":253,"label":"Sch\u00e9ma dentaire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"252","operator":"is","value":"y"},{"fieldId":"136","operator":"is","value":"replacement_svg"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":140,"label":"Etat de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"content":"[accordion] [accordion_item title=\"Instructions : A lire avant de continuer\"]Le sch\u00e9ma ci-dessous repr\u00e9sente une bouche saine comportant toutes ses dents. \nPlacez-vous devant un miroir pour modifier ce sch\u00e9ma et indiquer pr\u00e9cis\u00e9ment la situation de votre bouche en reproduisant exactement l'image que vous voyez dans le miroir:\n<ul><li>Commencez par retirer de votre bouche les proth\u00e8ses amovibles existantes (dentiers)<\/li><li>Pr\u00e9ciser exactement l'emplacement des dents absentes : pour cela, cliquer sur les dents absentes et s\u00e9lectionner dans la boite qui s'ouvre : \"Absente\".<\/li><ul>\n<li>Une dent qui n\u2019a pas pouss\u00e9 (dents de sagesse ou autre) est compt\u00e9e absente<\/li><\/ul><\/li><li>Il est souhaitable d'indiquer sur le sch\u00e9ma toute dent d\u00e9j\u00e0 \"cari\u00e9e, soign\u00e9e ou couronn\u00e9e.\"<ul><li>Une dent cass\u00e9e et\/ou partiellement enfouie sous la gencive est compt\u00e9e comme \"cari\u00e9e, soign\u00e9e, ou couronn\u00e9e\"<\/li><\/ul><\/li>\n<\/ul>[\/accordion_item][\/accordion]\n[doff-teeth svg=\"\/var\/www\/oraalgo.com\/wp-content\/plugins\/dental-office\/svg\/teethModel.svg\"]<hr \/>","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":109,"label":"missing","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":110,"label":"treated","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":112,"label":"static_prosthesis","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":113,"label":"removable_prosthesis","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":114,"label":"implants","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":120,"label":"bloody","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":121,"label":"pus","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":122,"label":"swollen","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":123,"label":"painful_gingiva","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":124,"label":"painful_teeth","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":125,"label":"mobile","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":127,"label":"lost_infection","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":128,"label":"old_gap","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":254,"label":"Informations compl\u00e9mentaires","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_svg"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":87,"label":"Pr\u00e9cisez le terrain, si besoin","adminLabel":"replacement_field_pb","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"J'ai des saignements de gencives","value":"blood","isSelected":false,"price":""},{"text":"J'ai des dents qui bougent","value":"moving","isSelected":false,"price":""},{"text":"Je grince des dents et je les use","value":"bruxism","isSelected":false,"price":""},{"text":"J'ai souvent du mal \u00e0 emboiter les dents du bas dans celles du haut","value":"occluso","isSelected":false,"price":""}],"inputs":[{"id":"87.1","label":"J'ai des saignements de gencives","name":""},{"id":"87.2","label":"J'ai des dents qui bougent","name":""},{"id":"87.3","label":"Je grince des dents et je les use","name":""},{"id":"87.4","label":"J'ai souvent du mal \u00e0 emboiter les dents du bas dans celles du haut","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_svg"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":217,"label":"Vous avez des pr\u00e9f\u00e9rences particuli\u00e8res en terme de proth\u00e8ses","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"Oui","isSelected":false,"price":""},{"text":"Non","value":"Non","isSelected":true,"price":""}],"formId":8,"description":"Vous souhaitez pr\u00e9ciser les types de proth\u00e8ses qui vous conviennent ou priviligier certains crit\u00e8res (prix, temps, etc...)","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":218,"label":"Vos pr\u00e9f\u00e9rences","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"217","operator":"is","value":"Oui"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"hidden","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":219,"label":"Quel crit\u00e8re souhaitez-vous privil\u00e9gier ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Le prix","value":"Le prix","isSelected":true,"price":""},{"text":"La dur\u00e9e du traitement","value":"La dur\u00e9e du traitement","isSelected":false,"price":""},{"text":"L'esth\u00e9tique","value":"L'esth\u00e9tique","isSelected":false,"price":""},{"text":"Le fait de ne pas abimer des dents saines","value":"Le fait de ne pas abimer des dents saines","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":220,"label":"Vos souhaits","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Je souhaite une proth\u00e8se fixe (pas de proth\u00e8se qui doive \u00eatre enlev\u00e9e de la bouche pour \u00eatre nettoy\u00e9e)","value":"Je souhaite une proth\u00e8se fixe (pas de proth\u00e8se qui doive \u00eatre enlev\u00e9e de la bouche pour \u00eatre nettoy\u00e9e)","isSelected":false,"price":""},{"text":"Je ne souhaite pas de rectification sur des dents saines et\/ou d'interventions chirurgicales d'am\u00e9nagement de la bouche avant la proth\u00e8se","value":"Je ne souhaite pas de rectification sur des dents saines et\/ou d'interventions chirurgicales d'am\u00e9nagement de la bouche avant la proth\u00e8se","isSelected":false,"price":""},{"text":"Je refuse les implants","value":"Je refuse les implants","isSelected":false,"price":""}],"inputs":[{"id":"220.1","label":"Je souhaite une proth\u00e8se fixe (pas de proth\u00e8se qui doive \u00eatre enlev\u00e9e de la bouche pour \u00eatre nettoy\u00e9e)","name":""},{"id":"220.2","label":"Je ne souhaite pas de rectification sur des dents saines et\/ou d'interventions chirurgicales d'am\u00e9nagement de la bouche avant la proth\u00e8se","name":""},{"id":"220.3","label":"Je refuse les implants","name":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":148,"label":"Entretien","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_maintenance"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":137,"label":"Je souhaite des informations sur l'entretien des proth\u00e8ses et\/ou des implants","adminLabel":"replacement_maintenance","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Pour l'entretien de proth\u00e8ses dentaires fixes (couronnes ou bridges)","value":"replacement_maintenance_df","isSelected":false,"price":""},{"text":"Pour l'entretien de proth\u00e8ses dentaires amovibles (appareils)","value":"replacement_maintenance_da","isSelected":false,"price":""},{"text":"Pour des proth\u00e8ses sur implants","value":"replacement_maintenance_implants","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":"","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":149,"label":"Probl\u00e8mes proth\u00e8ses\/implants","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_pb"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":138,"label":"J'ai de vrais soucis avec des...","adminLabel":"replacement_pb","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"proth\u00e8ses dentaires fixes (couronnes ou bridges)","value":"replacement_pb_df","isSelected":false,"price":""},{"text":"proth\u00e8ses dentaires amovibles","value":"replacement_pb_da","isSelected":false,"price":""},{"text":"proth\u00e8ses sur implants","value":"replacement_pb_implants","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":"","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":156,"label":"Pr\u00e9cisez","adminLabel":"replacement_pb_df","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Un couronne ou un bridge est tomb\u00e9 ou se d\u00e9tache r\u00e9guli\u00e8rement","value":"replacement_pb_df_detach","isSelected":false,"price":""},{"text":"Une couronne ou un bridge bouge sans s\u2019enlever compl\u00e8tement","value":"replacement_pb_df_move","isSelected":false,"price":""},{"text":"J\u2019ai des morceaux de c\u00e9ramiques cass\u00e9s et qui sont partis","value":"replacement_pb_df_broken","isSelected":false,"price":""},{"text":"Un bridge est cass\u00e9 en deux morceaux","value":"replacement_pb_df_totally_broken","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"138","operator":"is","value":"replacement_pb_df"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":157,"label":"Pr\u00e9cisez","adminLabel":"replacement_pb_da","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Mon appareil ne tient plus parce que ou un des crochets sont desserr\u00e9s ou cass\u00e9s","value":"replacement_pb_da_bracket","isSelected":false,"price":""},{"text":"La plaque base m\u00e9tallique est d\u00e9sadapt\u00e9e ou tordue","value":"replacement_pb_da_bent","isSelected":false,"price":""},{"text":"La plaque base en r\u00e9sine est f\u00eal\u00e9e ou cass\u00e9e","value":"replacement_pb_da_broken","isSelected":false,"price":""},{"text":"Des dents de sont d\u00e9tach\u00e9es de la plaque base","value":"replacement_pb_da_detach","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"138","operator":"is","value":"replacement_pb_da"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":158,"label":"Parmi les 3 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"replacement_pb_implants","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je n\u2019ai pas eu un examen scanner pour pr\u00e9parer le plan de traitement<br \/>On a pas pu mettre le nombre d\u2019implants pr\u00e9vus<br \/>On a pas pu mettre les implants aux emplacements pr\u00e9vus","value":"replacement_pb_implants_treatment","isSelected":false,"price":""},{"text":"Les implants remplacent des dents qui \u00e9taient infect\u00e9es<br \/>On voit le bord de ou des implants quand je souris<br \/>J\u2019ai la gencive qui saigne ou suppure au raz d\u2019un implant<br \/>J\u2019ai un implant qui bouge    J\u2019ai recommenc\u00e9 \u00e0 fumer","value":"replacement_pb_implants_surgery","isSelected":false,"price":""},{"text":"La couleur des dents de la proth\u00e8se permanente ne me conviennent pas<br \/>La forme des dents de la proth\u00e8se permanente ne me convient pas<br \/>L\u2019arrangement des dents de la proth\u00e8se permanente ne me convient pas<br \/>Ma proth\u00e8se sur implant est cass\u00e9e<br \/>Avec les proth\u00e8ses sur implants je ne sais plus comment mettre mes dents les unes en face des autres<br \/>Je continue \u00e0 grincer des dents pendant mon sommeil","value":"replacement_pb_implants_prosthesis","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"138","operator":"is","value":"replacement_pb_implants"}]},"formId":8,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":159,"label":"Vos implants et\/ou votre proth\u00e8se ont \u00e9t\u00e9 faits dans un pays \u00e9tranger ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"0","isSelected":true,"price":""},{"text":"Oui","value":"replacement_pb_abroad","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"136","operator":"is","value":"replacement_pb"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":160,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"replacement_pb_abroad","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Je suis all\u00e9(e) \u00e0 l\u2019\u00e9tranger parce que les dentistes fran\u00e7ais ne voulaient pas faire le travail que je souhaitais","value":"1","isSelected":false,"price":""},{"text":"C\u2019est parce que je vis en partie dans un pays \u00e9tranger que j\u2019y ai fait mes implants","value":"2","isSelected":false,"price":""},{"text":"C\u2019est pour des raisons \u00e9conomiques que j\u2019ai fait mes implants \u00e0 l\u2019\u00e9tranger","value":"3","isSelected":false,"price":""},{"text":"Je ne souhaite pas retourner dans la clinique \u00e0 l\u2019\u00e9tranger","value":"4","isSelected":false,"price":""},{"text":"La clinique \u00e0 l\u2019\u00e9tranger ne veut plus me donner de rendez vous","value":"5","isSelected":false,"price":""},{"text":"Je prends souvent des antibiotiques","value":"6","isSelected":false,"price":""},{"text":"Un dentiste fran\u00e7ais m\u2019a soulag\u00e9(e) mais ne veut plus me suivre","value":"7","isSelected":false,"price":""},{"text":"Mon dentiste fran\u00e7ais ne veut pas retoucher le travail fait \u00e0 l\u2019\u00e9tranger","value":"8","isSelected":false,"price":""},{"text":"Mon dentiste fran\u00e7ais n\u2019a pas les m\u00eames marques d\u2019implants","value":"9","isSelected":false,"price":""},{"text":"Je voudrais que ma proth\u00e8se soit r\u00e9par\u00e9e ou enlev\u00e9e","value":"10","isSelected":false,"price":""},{"text":"Je souhaite que mes implants infect\u00e9s soient retir\u00e9s","value":"11","isSelected":false,"price":""},{"text":"Je pr\u00eat(e) \u00e0 d\u00e9monter et refaire tout le travail en France","value":"12","isSelected":false,"price":""}],"inputs":[{"id":"160.1","label":"Je suis all\u00e9(e) \u00e0 l\u2019\u00e9tranger parce que les dentistes fran\u00e7ais ne voulaient pas faire le travail que je souhaitais","name":""},{"id":"160.2","label":"C\u2019est parce que je vis en partie dans un pays \u00e9tranger que j\u2019y ai fait mes implants","name":""},{"id":"160.3","label":"C\u2019est pour des raisons \u00e9conomiques que j\u2019ai fait mes implants \u00e0 l\u2019\u00e9tranger","name":""},{"id":"160.4","label":"Je ne souhaite pas retourner dans la clinique \u00e0 l\u2019\u00e9tranger","name":""},{"id":"160.5","label":"La clinique \u00e0 l\u2019\u00e9tranger ne veut plus me donner de rendez vous","name":""},{"id":"160.6","label":"Je prends souvent des antibiotiques","name":""},{"id":"160.7","label":"Un dentiste fran\u00e7ais m\u2019a soulag\u00e9(e) mais ne veut plus me suivre","name":""},{"id":"160.8","label":"Mon dentiste fran\u00e7ais ne veut pas retoucher le travail fait \u00e0 l\u2019\u00e9tranger","name":""},{"id":"160.9","label":"Mon dentiste fran\u00e7ais n\u2019a pas les m\u00eames marques d\u2019implants","name":""},{"id":"160.11","label":"Je voudrais que ma proth\u00e8se soit r\u00e9par\u00e9e ou enlev\u00e9e","name":""},{"id":"160.12","label":"Je souhaite que mes implants infect\u00e9s soient retir\u00e9s","name":""},{"id":"160.13","label":"Je pr\u00eat(e) \u00e0 d\u00e9monter et refaire tout le travail en France","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"159","operator":"is","value":"replacement_pb_abroad"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":175,"label":"Dents","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"59","operator":"is","value":"teeth_decay_choice"},{"fieldId":"59","operator":"is","value":"teeth_milk_painful"},{"fieldId":"59","operator":"is","value":"teeth_bruxomania"},{"fieldId":"59","operator":"is","value":"teeth_broken"},{"fieldId":"59","operator":"is","value":"teeth_extraction_pain"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":170,"label":"Parmi les 2 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"teeth_broken","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"C\u2019est arriv\u00e9 en mangeant.","value":"teeth_cracked_eating","isSelected":false,"price":""},{"text":"C\u2019est arriv\u00e9 avec un choc, une chute, ou un coup.","value":"teeth_cracked_shock","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"59","operator":"is","value":"teeth_broken"}]},"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":164,"label":"Parmi les 2 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"teeth_erosion_or_bruxism","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je crois que je grince des dents pendant mon sommeil, ou que je serre tr\u00e8s souvent les dents pendant la journ\u00e9e","value":"abrasion","isSelected":false,"price":""},{"text":"J\u2019aime les sodas (colas, jus de fruits, limonades\u2026), ou les agrumes (citrons, oranges, pamplemousse\u2026), ou le vinaigre (salades, cornichons\u2026)","value":"teeth_erosion","isSelected":false,"price":""},{"text":"Je ne grince pas des dents et je n\u2019aime pas les produits acides","value":"no_result_found","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"59","operator":"is","value":"teeth_bruxomania"}]},"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":85,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"teeth_healthy_painful","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"En regardant avec une bonne lumi\u00e8re je crois voir sur la dent une petite t\u00e2che plus sombre ou une opacit\u00e9 de l\u2019\u00e9mail","value":"1","isSelected":false,"price":""},{"text":"Je crois percevoir avec la langue un petit trou de la dent, du cot\u00e9 int\u00e9rieur","value":"2","isSelected":false,"price":""},{"text":"Le tr\u00e8s froid d\u00e9clenche une douleur sur cette dent pr\u00e9cise","value":"3","isSelected":false,"price":""},{"text":"Le sucre ou le chocolat d\u00e9clenche une douleur sur cette dent pr\u00e9cise","value":"4","isSelected":false,"price":""},{"text":"C\u2019est le fait de manger sur cette dent qui peut d\u00e9clencher la douleur","value":"5","isSelected":false,"price":""}],"inputs":[{"id":"85.1","label":"En regardant avec une bonne lumi\u00e8re je crois voir sur la dent une petite t\u00e2che plus sombre ou une opacit\u00e9 de l\u2019\u00e9mail","name":""},{"id":"85.2","label":"Je crois percevoir avec la langue un petit trou de la dent, du cot\u00e9 int\u00e9rieur","name":""},{"id":"85.3","label":"Le tr\u00e8s froid d\u00e9clenche une douleur sur cette dent pr\u00e9cise","name":""},{"id":"85.4","label":"Le sucre ou le chocolat d\u00e9clenche une douleur sur cette dent pr\u00e9cise","name":""},{"id":"85.5","label":"C\u2019est le fait de manger sur cette dent qui peut d\u00e9clencher la douleur","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","enableChoiceValue":true,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":"is","value":"200"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":83,"label":"Parmi les 7 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"teeth_cracked_shock","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Le choc a \u00e9branl\u00e9 une ou plusieurs dents qui ne sont pourtant ni f\u00eal\u00e9es, ni \u00e9br\u00e9ch\u00e9es ni cass\u00e9es. Elles peuvent \u00eatre l\u00e9g\u00e8rement mobiles.","value":"teeth_cracked_shock_contusion","isSelected":false,"price":""},{"text":"Il n\u2019y a que le bord ou les angles des dents qui sont \u00e9br\u00e9ch\u00e9s ou fractur\u00e9s. On ne voit pas de point rouge dans ces zones.","value":"teeth_cracked_shock_without_pulp","isSelected":false,"price":""},{"text":"On voit un point rouge au milieu d\u2019une dent dont un gros morceau est cass\u00e9.","value":"teeth_cracked_shock_with_pulp","isSelected":false,"price":""},{"text":"La ou les dents ont \u00e9t\u00e9 l\u00e9g\u00e8rement d\u00e9plac\u00e9es par le choc, sans \u00eatre vraiment cass\u00e9e(s) Une ou plusieurs dent sont l\u00e9g\u00e8rement plus longues ou plus enfonc\u00e9es \u00e0 la suite du choc","value":"teeth_cracked_shock_lux_without_crack","isSelected":false,"price":""},{"text":"La ou les dents on \u00e9t\u00e9 nettement d\u00e9plac\u00e9es ou enfonc\u00e9es La gencive saigne autour des dents d\u00e9plac\u00e9es","value":"teeth_cracked_shock_lux_with_crack","isSelected":false,"price":""},{"text":"La ou les dents ont \u00e9t\u00e9 \u00e9ject\u00e9es de ma bouche La gencive saigne \u00e0 l'endroit ou \u00e9taient la (ou les) dents \u00e9ject\u00e9es","value":"teeth_cracked_shock_complete_lux","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"170","operator":"is","value":"teeth_cracked_shock"}]},"displayOnly":"","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":180,"label":"Le nerf de la dent a d\u00e9j\u00e0 \u00e9t\u00e9 enlev\u00e9","adminLabel":"teeth","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"teeth_abcess","isSelected":false,"price":""},{"text":"Non","value":"teeth_decay","isSelected":false,"price":""},{"text":"Je ne sais pas","value":"teeth_decay","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"59","operator":"is","value":"teeth_decay_choice"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":62,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"teeth_abcess","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Les douleurs sont augment\u00e9es par la chaleur","value":"7","isSelected":false,"price":""},{"text":"Je sens les battements de mon c\u0153ur dans la gencive","value":"4","isSelected":false,"price":""},{"text":"Les douleurs sont augment\u00e9es en position allong\u00e9e","value":"1","isSelected":false,"price":""},{"text":"Le douleur est pr\u00e9sente en permanence","value":"8","isSelected":false,"price":""},{"text":"La douleur se diffuse dans la m\u00e2choire","value":"10","isSelected":false,"price":""},{"text":"La dent semble plus longue que les autres quand je ferme la bouche","value":"11","isSelected":false,"price":""},{"text":"La gencive est gonfl\u00e9e autour de la dent","value":"12","isSelected":false,"price":""}],"inputs":[{"id":"62.1","label":"Les douleurs sont augment\u00e9es par la chaleur","name":""},{"id":"62.2","label":"Je sens les battements de mon c\u0153ur dans la gencive","name":""},{"id":"62.3","label":"Les douleurs sont augment\u00e9es en position allong\u00e9e","name":""},{"id":"62.4","label":"Le douleur est pr\u00e9sente en permanence","name":""},{"id":"62.5","label":"La douleur se diffuse dans la m\u00e2choire","name":""},{"id":"62.6","label":"La dent semble plus longue que les autres quand je ferme la bouche","name":""},{"id":"62.7","label":"La gencive est gonfl\u00e9e autour de la dent","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"180","operator":"is","value":"teeth_abcess"}]},"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":181,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"teeth_decay","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Le sucr\u00e9 (chocolat, confiture\u2026) d\u00e9clenche la douleur","value":"5","isSelected":false,"price":""},{"text":"Le froid d\u00e9clenche la douleur","value":"2","isSelected":false,"price":""},{"text":"La douleur caus\u00e9e par le froid dure plus de 30 secondes","value":"6","isSelected":false,"price":""},{"text":"Les douleurs sont augment\u00e9es par la chaleur","value":"7","isSelected":false,"price":""},{"text":"Je sens les battements de mon c\u0153ur dans la dent","value":"4","isSelected":false,"price":""},{"text":"Je sens les battements de mon c\u0153ur dans la gencive","value":"9","isSelected":false,"price":""},{"text":"Les douleurs sont augment\u00e9es en position allong\u00e9e","value":"1","isSelected":false,"price":""},{"text":"Le douleur est pr\u00e9sente en permanence","value":"8","isSelected":false,"price":""},{"text":"La douleur se diffuse dans la m\u00e2choire","value":"10","isSelected":false,"price":""},{"text":"La dent semble plus longue que les autres quand je ferme la bouche","value":"11","isSelected":false,"price":""},{"text":"La gencive est gonfl\u00e9e autour de la dent","value":"12","isSelected":false,"price":""}],"inputs":[{"id":"181.1","label":"Le sucr\u00e9 (chocolat, confiture\u2026) d\u00e9clenche la douleur","name":""},{"id":"181.2","label":"Le froid d\u00e9clenche la douleur","name":""},{"id":"181.3","label":"La douleur caus\u00e9e par le froid dure plus de 30 secondes","name":""},{"id":"181.4","label":"Les douleurs sont augment\u00e9es par la chaleur","name":""},{"id":"181.5","label":"Je sens les battements de mon c\u0153ur dans la dent","name":""},{"id":"181.6","label":"Je sens les battements de mon c\u0153ur dans la gencive","name":""},{"id":"181.7","label":"Les douleurs sont augment\u00e9es en position allong\u00e9e","name":""},{"id":"181.8","label":"Le douleur est pr\u00e9sente en permanence","name":""},{"id":"181.9","label":"La douleur se diffuse dans la m\u00e2choire","name":""},{"id":"181.11","label":"La dent semble plus longue que les autres quand je ferme la bouche","name":""},{"id":"181.12","label":"La gencive est gonfl\u00e9e autour de la dent","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"180","operator":"is","value":"teeth_decay"}]},"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":167,"label":"La plupart des dents de l\u2019enfant sont cari\u00e9es","adminLabel":"teeth_child","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"teeth_polydecay","isSelected":false,"price":""},{"text":"Non","value":"Non","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"59","operator":"is","value":"teeth_milk_painful"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":63,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 sa situation (seulement celles-l\u00e0)","adminLabel":"teeth_milk_painful","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"L\u2019enfant se plaint de douleurs li\u00e9es \u00e0 la mobilit\u00e9 de la dent","value":"2","isSelected":false,"price":""},{"text":"L\u2019enfant a mordu brutalement sur la dent et sa mobilit\u00e9 a fortement augment\u00e9","value":"3","isSelected":false,"price":""},{"text":"La dent douloureuse est trou\u00e9e (carie) ou porteuse de t\u00e2ches noires","value":"4","isSelected":false,"price":""},{"text":"Les douleurs sont augment\u00e9es par le chaud ou le froid","value":"5","isSelected":false,"price":""},{"text":"La dent douloureuse a d\u00e9j\u00e0 \u00e9t\u00e9 soign\u00e9e et porte un gros plombage (obturation)","value":"6","isSelected":false,"price":""},{"text":"La gencive est rouge et gonfl\u00e9e autour de la dent douloureuse","value":"7","isSelected":false,"price":""},{"text":"L\u2019enfant se plaint pendant les repas ou apr\u00e8s les repas","value":"8","isSelected":false,"price":""},{"text":"On voit des d\u00e9bris d\u2019aliments coinc\u00e9s entre la dent douloureuse et la voisine","value":"9","isSelected":false,"price":""}],"inputs":[{"id":"63.1","label":"L\u2019enfant se plaint de douleurs li\u00e9es \u00e0 la mobilit\u00e9 de la dent","name":""},{"id":"63.2","label":"L\u2019enfant a mordu brutalement sur la dent et sa mobilit\u00e9 a fortement augment\u00e9","name":""},{"id":"63.3","label":"La dent douloureuse est trou\u00e9e (carie) ou porteuse de t\u00e2ches noires","name":""},{"id":"63.4","label":"Les douleurs sont augment\u00e9es par le chaud ou le froid","name":""},{"id":"63.5","label":"La dent douloureuse a d\u00e9j\u00e0 \u00e9t\u00e9 soign\u00e9e et porte un gros plombage (obturation)","name":""},{"id":"63.6","label":"La gencive est rouge et gonfl\u00e9e autour de la dent douloureuse","name":""},{"id":"63.7","label":"L\u2019enfant se plaint pendant les repas ou apr\u00e8s les repas","name":""},{"id":"63.8","label":"On voit des d\u00e9bris d\u2019aliments coinc\u00e9s entre la dent douloureuse et la voisine","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"167","operator":"is","value":"Non"}]},"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":84,"label":"Parmi les 4 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"teeth_extraction_pain","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Ma dent a \u00e9t\u00e9 enlev\u00e9e il y a moins de 48h. Le dentiste n'a pas eu de difficult\u00e9 particuli\u00e8re pour l'extraction. La douleur est p\u00e9nible mais ne m'emp\u00eache pas de dormir","value":"teeth_extraction_pain_post","isSelected":false,"price":""},{"text":"L\u2019extraction de la dent a \u00e9t\u00e9 longue et difficile. Elle a \u00e9t\u00e9 faite il y a moins de 48h et je ne peux pas dormir.","value":"teeth_extraction_big_pain_post","isSelected":false,"price":""},{"text":"Ma dent a \u00e9t\u00e9 enl\u00e9v\u00e9e il y a 3 jours ou plus. La douleur est tr\u00e8s vive et diffuse sur le cot\u00e9 du visage. La douleur m'emp\u00eache de dormir et ne diminue pas. L'endroit ou \u00e9tait ma dent est vide, ou bouch\u00e9 par des d\u00e9bris alimentaires et ne saigne pas","value":"teeth_extraction_pain_a_dry","isSelected":false,"price":""},{"text":"Ma dent a \u00e9t\u00e9 enlev\u00e9e depuis plus de 2 jours. La douleur est sourde, a peine calm\u00e9e par l'aspirine. L'endroit ou \u00e9tait ma dent est bouch\u00e9 par un caillot sanguinolent ou purulent<br \/>J'ai un ganglion sous la machoire","value":"teeth_extraction_pain_a_pus","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"59","operator":"is","value":"teeth_extraction_pain"}]},"enableChoiceValue":true,"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":176,"label":"M\u00e2choire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"19","operator":"is","value":"occluso_articular"},{"fieldId":"19","operator":"is","value":"occluso_muscular"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":171,"label":"Je souffre de la m\u00e2choire, de la t\u00eate, ou du cou. Il n\u2019y a jamais eu de bruit dans l\u2019articulation. Les mouvements de ma m\u00e2choire sont limit\u00e9s ou impossibles.","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Je suis inquiet(e), tendu(e) ou stress\u00e9(e)","value":"occluso_muscular_algo","isSelected":false,"price":""},{"text":"Je ne peux presque plus bouger la m\u00e2choire \u00e0 la suite d\u2019un choc violent ou d\u2019une blessure ou d\u2019une piq\u00fbre, sur un muscle de la m\u00e2choire (r\u00e9gion de la joue ou de la tempe)","value":"myosite","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"19","operator":"is","value":"occluso_muscular"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","adminLabel":"occluso_muscular_algo","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":[{"text":"J\u2019ai r\u00e9guli\u00e8rement des douleurs en d\u2019autres points du corps","value":"1","isSelected":false,"price":""},{"text":"J\u2019ai consult\u00e9 plusieurs m\u00e9decins ou chirurgiens dentistes sans soulagement durable","value":"2","isSelected":false,"price":""},{"text":"Je prends des m\u00e9dicaments pour ces douleurs","value":"3","isSelected":false,"price":""},{"text":"Je souffre depuis plus de 6 mois","value":"4","isSelected":false,"price":""},{"text":"Je serre souvent les dents dans la journ\u00e9e","value":"5","isSelected":false,"price":""},{"text":"Le matin j\u2019ai souvent du mal \u00e0 ouvrir compl\u00e8tement ma bouche","value":"6","isSelected":false,"price":""},{"text":"J\u2019ai eu des dents extraites (remplac\u00e9es ou non)","value":"7","isSelected":false,"price":""},{"text":"J\u2019ai eu un traitement pour redresser mes dents","value":"8","isSelected":false,"price":""},{"text":"J'ai d\u00e9j\u00e0 eu une goutti\u00e8re occlusale","value":"9","isSelected":false,"price":""},{"text":"Mes dents ne tombent pas bien les unes en face des autres","value":"10","isSelected":false,"price":""}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"171","operator":"is","value":"occluso_muscular_algo"}]},"cssClass":"","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","errorMessage":"","formId":8,"id":172,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":[{"id":"172.1","label":"J\u2019ai r\u00e9guli\u00e8rement des douleurs en d\u2019autres points du corps","name":""},{"id":"172.2","label":"J\u2019ai consult\u00e9 plusieurs m\u00e9decins ou chirurgiens dentistes sans soulagement durable","name":""},{"id":"172.3","label":"Je prends des m\u00e9dicaments pour ces douleurs","name":""},{"id":"172.4","label":"Je souffre depuis plus de 6 mois","name":""},{"id":"172.5","label":"Je serre souvent les dents dans la journ\u00e9e","name":""},{"id":"172.6","label":"Le matin j\u2019ai souvent du mal \u00e0 ouvrir compl\u00e8tement ma bouche","name":""},{"id":"172.7","label":"J\u2019ai eu des dents extraites (remplac\u00e9es ou non)","name":""},{"id":"172.8","label":"J\u2019ai eu un traitement pour redresser mes dents","name":""},{"id":"172.9","label":"J'ai d\u00e9j\u00e0 eu une goutti\u00e8re occlusale","name":""},{"id":"172.11","label":"Mes dents ne tombent pas bien les unes en face des autres","name":""}],"isRequired":true,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","adminLabel":"occluso_articular","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","value":"1"},{"isSelected":false,"price":"","text":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","value":"2"},{"isSelected":false,"price":"","text":"Je dors sur le ventre","value":"3"},{"isSelected":false,"price":"","text":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","value":"4"},{"isSelected":false,"price":"","text":"J\u2019ai des craquements (bruit net, de type claquement) dans l\u2019articulation, \u00e0 l'ouverture et \u00e0 la fermeture de la machoire","value":"5"},{"isSelected":false,"price":"","text":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","value":"6"},{"isSelected":false,"price":"","text":"Je ne peux plus ouvrir la bouche compl\u00e8tement","value":"7"},{"isSelected":false,"price":"","text":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","value":"8"},{"isSelected":false,"price":"","text":"J\u2019ai des bruits comme des cr\u00e9pitations, comme du sable, dans l\u2019articulation","value":"9"},{"isSelected":false,"price":"","text":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","value":"10"},{"isSelected":false,"price":"","text":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","value":"11"}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"19","operator":"is","value":"occluso_articular"}]},"cssClass":"","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","errorMessage":"","formId":8,"id":20,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":[{"id":"20.1","label":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","name":""},{"id":"20.2","label":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","name":""},{"id":"20.3","label":"Je dors sur le ventre","name":""},{"id":"20.4","label":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","name":""},{"id":"20.5","label":"J\u2019ai des craquements (bruit net, de type claquement) dans l\u2019articulation, \u00e0 l'ouverture et \u00e0 la fermeture de la machoire","name":""},{"id":"20.6","label":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","name":""},{"id":"20.7","label":"Je ne peux plus ouvrir la bouche compl\u00e8tement","name":""},{"id":"20.8","label":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","name":""},{"id":"20.9","label":"J\u2019ai des bruits comme des cr\u00e9pitations, comme du sable, dans l\u2019articulation","name":""},{"id":"20.11","label":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","name":""},{"id":"20.12","label":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","name":""}],"isRequired":false,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":309,"label":"L\u2019articulation de la m\u00e2choire craque (ou a craqu\u00e9), ou se bloque quand j\u2019ouvre ou je ferme la bouche","adminLabel":"occluso_articular","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Il y a du bruit dans l'articulation.","value":"occluso_articular_noise","isSelected":false,"price":""},{"text":"Il n'y a pas de bruit dans l'articulation (mais il y a pu en avoir pr\u00e9c\u00e9demment)","value":"occluso_articular_no_noise","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"19","operator":"is","value":"occluso_articular"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","adminLabel":"occluso_articular_noise","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","value":"1"},{"isSelected":false,"price":"","text":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","value":"2"},{"isSelected":false,"price":"","text":"Je dors sur le ventre","value":"3"},{"isSelected":false,"price":"","text":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","value":"4"},{"isSelected":false,"price":"","text":"J\u2019ai des craquements (bruit net,  de type claquement) dans l\u2019articulation, \u00e0 l'ouverture et \u00e0 la fermeture de la machoire","value":"5"},{"isSelected":false,"price":"","text":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","value":"6"},{"isSelected":false,"price":"","text":"Je ne peux plus ouvrir la bouche compl\u00e8tement","value":"7"},{"isSelected":false,"price":"","text":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","value":"8"},{"isSelected":false,"price":"","text":"J\u2019ai des bruits comme des cr\u00e9pitations, comme du sable, dans l\u2019articulation","value":"9"},{"isSelected":false,"price":"","text":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","value":"10"},{"isSelected":false,"price":"","text":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","value":"11"}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"309","operator":"is","value":"occluso_articular_noise"}]},"cssClass":"","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","errorMessage":"","formId":8,"id":310,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":[{"id":"310.1","label":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","name":""},{"id":"310.2","label":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","name":""},{"id":"310.3","label":"Je dors sur le ventre","name":""},{"id":"310.4","label":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","name":""},{"id":"310.5","label":"J\u2019ai des craquements (bruit net,  de type claquement) dans l\u2019articulation, \u00e0 l'ouverture et \u00e0 la fermeture de la machoire","name":""},{"id":"310.6","label":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","name":""},{"id":"310.7","label":"Je ne peux plus ouvrir la bouche compl\u00e8tement","name":""},{"id":"310.8","label":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","name":""},{"id":"310.9","label":"J\u2019ai des bruits comme des cr\u00e9pitations, comme du sable, dans l\u2019articulation","name":""},{"id":"310.11","label":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","name":""},{"id":"310.12","label":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","name":""}],"isRequired":true,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","adminLabel":"occluso_articular_no_noise","allowsPrepopulate":false,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","value":"1"},{"isSelected":false,"price":"","text":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","value":"2"},{"isSelected":false,"price":"","text":"Je dors sur le ventre","value":"3"},{"isSelected":false,"price":"","text":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","value":"4"},{"isSelected":false,"price":"","text":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","value":"6"},{"isSelected":false,"price":"","text":"Je ne peux plus ouvrir la bouche compl\u00e8tement","value":"7"},{"isSelected":false,"price":"","text":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","value":"8"},{"isSelected":false,"price":"","text":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","value":"10"},{"isSelected":false,"price":"","text":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","value":"11"}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"309","operator":"is","value":"occluso_articular_no_noise"}]},"cssClass":"","defaultValue":"","description":"","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"enableCalculation":"","errorMessage":"","formId":8,"id":311,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":[{"id":"311.1","label":"J\u2019ai eu un choc sur la m\u00e2choire ou l\u2019articulation, ou un coup du lapin","name":""},{"id":"311.2","label":"Je suis tr\u00e8s souple ou, j\u2019ai des articulations, des membres, des doigts ou du dos qui craquent facilement","name":""},{"id":"311.3","label":"Je dors sur le ventre","name":""},{"id":"311.4","label":"J\u2019ai eu les dents de sagesse extraites sous anesth\u00e9sie g\u00e9n\u00e9rale","name":""},{"id":"311.5","label":"J\u2019avais un craquement dans l\u2019articulation depuis un moment, mais il a disparu depuis le blocage.","name":""},{"id":"311.6","label":"Je ne peux plus ouvrir la bouche compl\u00e8tement","name":""},{"id":"311.7","label":"J\u2019ai une douleur si je force pour ouvrir la m\u00e2choire","name":""},{"id":"311.8","label":"Les douleurs sont augment\u00e9es par tous les mouvements de la m\u00e2choire","name":""},{"id":"311.9","label":"Je suis atteint(e) d\u2019arthrite rhumato\u00efde ou de rhumatisme","name":""}],"isRequired":true,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":21,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Je souffre de maux de t\u00eate, du cou ou des \u00e9paules dont l\u2019origine est inconnue","value":"1","isSelected":false,"price":""},{"text":"La douleur est plus importante ou dure plus longtemps quand je suis stress\u00e9(e)","value":"2","isSelected":false,"price":""},{"text":"Le matin je me r\u00e9veille souvent sur le ventre","value":"3","isSelected":false,"price":""},{"text":"Le matin j\u2019ai souvent du mal \u00e0 ouvrir compl\u00e8tement ma bouche","value":"4","isSelected":false,"price":""},{"text":"La limitation d\u2019ouverture de la bouche dure parfois toute la journ\u00e9e","value":"5","isSelected":false,"price":""},{"text":"Il m'arrive d'avoir des douleurs ou des crampes dans la m\u00e2choire","value":"6","isSelected":false,"price":""},{"text":"J\u2019ai parfois du mal \u00e0 savoir comment poser mes dents les unes en face des autres","value":"7","isSelected":false,"price":""},{"text":"J\u2019ai eu des dents extraites, non remplac\u00e9es, ou remplac\u00e9es par des proth\u00e8ses","value":"8","isSelected":false,"price":""},{"text":"J\u2019ai eu un traitement pour redresser mes dents","value":"11","isSelected":false,"price":""},{"text":"Je consulte un kin\u00e9sith\u00e9rapeute ou un ost\u00e9opathe qui me soulage temporairement","value":"12","isSelected":false,"price":""},{"text":"J\u2019ai eu un choc violent ou une blessure ou une piq\u00fbre sur un muscle de la m\u00e2choire (r\u00e9gion de la joue ou de la temps)","value":"13","isSelected":false,"price":""},{"text":"J\u2019ai eu des ligatures pour bloquer mes arcades apr\u00e8s chirurgie","value":"14","isSelected":false,"price":""}],"inputs":[{"id":"21.1","label":"Je souffre de maux de t\u00eate, du cou ou des \u00e9paules dont l\u2019origine est inconnue","name":""},{"id":"21.2","label":"La douleur est plus importante ou dure plus longtemps quand je suis stress\u00e9(e)","name":""},{"id":"21.3","label":"Le matin je me r\u00e9veille souvent sur le ventre","name":""},{"id":"21.4","label":"Le matin j\u2019ai souvent du mal \u00e0 ouvrir compl\u00e8tement ma bouche","name":""},{"id":"21.5","label":"La limitation d\u2019ouverture de la bouche dure parfois toute la journ\u00e9e","name":""},{"id":"21.6","label":"Il m'arrive d'avoir des douleurs ou des crampes dans la m\u00e2choire","name":""},{"id":"21.7","label":"J\u2019ai parfois du mal \u00e0 savoir comment poser mes dents les unes en face des autres","name":""},{"id":"21.8","label":"J\u2019ai eu des dents extraites, non remplac\u00e9es, ou remplac\u00e9es par des proth\u00e8ses","name":""},{"id":"21.9","label":"J\u2019ai eu un traitement pour redresser mes dents","name":""},{"id":"21.11","label":"Je consulte un kin\u00e9sith\u00e9rapeute ou un ost\u00e9opathe qui me soulage temporairement","name":""},{"id":"21.12","label":"J\u2019ai eu un choc violent ou une blessure ou une piq\u00fbre sur un muscle de la m\u00e2choire (r\u00e9gion de la joue ou de la temps)","name":""},{"id":"21.13","label":"J\u2019ai eu des ligatures pour bloquer mes arcades apr\u00e8s chirurgie","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":"","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"administrative","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":22,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"J\u2019ai consult\u00e9 plusieurs m\u00e9decins ou chirurgiens dentistes pour des douleurs de la t\u00eate, des \u00e9paules ou du dos","value":"1","isSelected":false,"price":""},{"text":"Je suis trait\u00e9 pour ces douleurs mais je n\u2019ai pas obtenu de soulagement durable","value":"2","isSelected":false,"price":""},{"text":"Je serre souvent les dents dans la journ\u00e9e","value":"3","isSelected":false,"price":""},{"text":"Je suis temporairement soulag\u00e9 par un kin\u00e9sith\u00e9rapeute ou un ost\u00e9opathe","value":"4","isSelected":false,"price":""},{"text":"J\u2019ai eu un choc violent sur le visage, ou les m\u00e2choires, ou sur le cou","value":"5","isSelected":false,"price":""},{"text":"J'ai eu de gros soucis personnels","value":"6","isSelected":false,"price":""},{"text":"J\u2019ai des dents manquantes, non remplac\u00e9es, ou remplac\u00e9es par des proth\u00e8ses","value":"8","isSelected":false,"price":""},{"text":"J'ai eu un traitement pour redresser mes dents","value":"9","isSelected":false,"price":""},{"text":"J'ai parfois du mal \u00e0 savoir comment poser mes dents les unes contre les autres","value":"10","isSelected":false,"price":""},{"text":"J'ai d\u00e9j\u00e0 eu une goutti\u00e8re occlusale","value":"11","isSelected":false,"price":""}],"inputs":[{"id":"22.1","label":"J\u2019ai consult\u00e9 plusieurs m\u00e9decins ou chirurgiens dentistes pour des douleurs de la t\u00eate, des \u00e9paules ou du dos","name":""},{"id":"22.2","label":"Je suis trait\u00e9 pour ces douleurs mais je n\u2019ai pas obtenu de soulagement durable","name":""},{"id":"22.3","label":"Je serre souvent les dents dans la journ\u00e9e","name":""},{"id":"22.4","label":"Je suis temporairement soulag\u00e9 par un kin\u00e9sith\u00e9rapeute ou un ost\u00e9opathe","name":""},{"id":"22.5","label":"J\u2019ai eu un choc violent sur le visage, ou les m\u00e2choires, ou sur le cou","name":""},{"id":"22.6","label":"J'ai eu de gros soucis personnels","name":""},{"id":"22.7","label":"J\u2019ai des dents manquantes, non remplac\u00e9es, ou remplac\u00e9es par des proth\u00e8ses","name":""},{"id":"22.8","label":"J'ai eu un traitement pour redresser mes dents","name":""},{"id":"22.9","label":"J'ai parfois du mal \u00e0 savoir comment poser mes dents les unes contre les autres","name":""},{"id":"22.11","label":"J'ai d\u00e9j\u00e0 eu une goutti\u00e8re occlusale","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"administrative","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":177,"label":"Gencives","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"24","operator":"is","value":"perio_perio_30"},{"fieldId":"24","operator":"is","value":"perio_already_sick"},{"fieldId":"24","operator":"is","value":"perio_abscess_to_confirm"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":169,"label":"Vous n\u2019arrivez pas \u00e0 la soigner compl\u00e8tement une maladie de gencive","adminLabel":"perio_already_sick","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Le dentiste n\u2019a pas envisag\u00e9 un programme de maintenance","value":"perio_already_sick_no_maintenance","isSelected":false,"price":""},{"text":"J\u2019ai des difficult\u00e9s pour respecter totalement le programme de maintenance","value":"perio_already_sick_cannot_do_it","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"24","operator":"is","value":"perio_already_sick"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":25,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"perio_abscess_sure","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"La dent bouge depuis des semaines ou des mois","value":"1","isSelected":false,"price":""},{"text":"Il y a parfois du pus \u00e0 la jonction entre la dent et la gencive","value":"4","isSelected":false,"price":""},{"text":"La gencive est gonfl\u00e9e au niveau de la racine","value":"5","isSelected":false,"price":""},{"text":"Il y a un point blanc \u00e0 l'endroit le plus gonfl\u00e9 de la gencive","value":"6","isSelected":false,"price":""},{"text":"Le nerf de la dent a d\u00e9j\u00e0 \u00e9t\u00e9 enlev\u00e9","value":"7","isSelected":false,"price":""},{"text":"Il y a une grosse carie sur la dent","value":"8","isSelected":false,"price":""},{"text":"La dent est devenue tr\u00e8s douloureuse tr\u00e8s rapidement (1 ou 2 jours)","value":"9","isSelected":false,"price":""}],"inputs":[{"id":"25.1","label":"La dent bouge depuis des semaines ou des mois","name":""},{"id":"25.2","label":"Il y a parfois du pus \u00e0 la jonction entre la dent et la gencive","name":""},{"id":"25.3","label":"La gencive est gonfl\u00e9e au niveau de la racine","name":""},{"id":"25.4","label":"Il y a un point blanc \u00e0 l'endroit le plus gonfl\u00e9 de la gencive","name":""},{"id":"25.5","label":"Le nerf de la dent a d\u00e9j\u00e0 \u00e9t\u00e9 enlev\u00e9","name":""},{"id":"25.6","label":"Il y a une grosse carie sur la dent","name":""},{"id":"25.7","label":"La dent est devenue tr\u00e8s douloureuse tr\u00e8s rapidement (1 ou 2 jours)","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"308","operator":"is","value":"perio_abscess_sure"}]},"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":312,"label":"Pr\u00e9ciser","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"24","operator":"is","value":"perio_perio_30"},{"fieldId":"308","operator":"is","value":"perio_perio_30"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":184,"label":"Ma gencive est enflamm\u00e9e (rougeur, ou gonflement ou saignement ou douleur). Certaines dents sont d\u00e9chauss\u00e9es ou mobiles.","adminLabel":"perio_perio_minus30","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Vous savez que votre brossage est insuffisant et certaines dents sont un peu d\u00e9chauss\u00e9es mais non mobiles","value":"paro_super","isSelected":false,"price":""},{"text":"Malgr\u00e9 le brossage tr\u00e8s r\u00e9gulier de vos dents, certaines sont d\u00e9chauss\u00e9e ou se sont mises \u00e0 bouger. Des espaces peuvent appara\u00eetre entre les dents. Certaines ont peut-\u00eatre \u00e9t\u00e9 perdues","value":"paro_agressive","isSelected":false,"price":""},{"text":"Les bords de votre gencive sont tr\u00e8s abim\u00e9s, d\u2019une teinte gris\u00e2tre. Le brossage n\u2019est pas possible car trop douloureux. Vous \u00eates fatigu\u00e9 ou avez de la fi\u00e8vre","value":"GUN","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":"<","value":"30"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":26,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"perio_perio_30","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Il y a de la plaque dentaire ou du tartre dans la r\u00e9gion o\u00f9 la gencive est enflamm\u00e9 (rouge, gonfl\u00e9e, douloureuse,\u2026)","value":"1","isSelected":false,"price":""},{"text":"Vous avez des dents d\u00e9chauss\u00e9es dont on voit le d\u00e9but des racines, mais qui ne bougent pas.","value":"2","isSelected":false,"price":""},{"text":"Des espaces apparaissent, entre des dents qui se d\u00e9placent petit \u00e0 petit.","value":"3","isSelected":false,"price":""},{"text":"Vous avez des dents qui bougent, ou dont la mobilit\u00e9 augmente.","value":"4","isSelected":false,"price":""},{"text":"Vous avez d\u00e9j\u00e0 perdu une ou plusieurs dents par d\u00e9chaussement.","value":"5","isSelected":false,"price":""}],"inputs":[{"id":"26.1","label":"Il y a de la plaque dentaire ou du tartre dans la r\u00e9gion o\u00f9 la gencive est enflamm\u00e9 (rouge, gonfl\u00e9e, douloureuse,\u2026)","name":""},{"id":"26.2","label":"Vous avez des dents d\u00e9chauss\u00e9es dont on voit le d\u00e9but des racines, mais qui ne bougent pas.","name":""},{"id":"26.3","label":"Des espaces apparaissent, entre des dents qui se d\u00e9placent petit \u00e0 petit.","name":""},{"id":"26.4","label":"Vous avez des dents qui bougent, ou dont la mobilit\u00e9 augmente.","name":""},{"id":"26.5","label":"Vous avez d\u00e9j\u00e0 perdu une ou plusieurs dents par d\u00e9chaussement.","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"154","operator":">","value":"29"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":178,"label":"Esth\u00e9tique du sourire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_info"},{"fieldId":"35","operator":"is","value":"aesthetic_odf"},{"fieldId":"35","operator":"is","value":"aesthetic_gingiva"},{"fieldId":"35","operator":"is","value":"aesthetic_minimal"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":37,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"aesthetic_info","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Je redoute d\u2019engager de v\u00e9ritables modifications de mes dents","value":"1","isSelected":false,"price":""},{"text":"Je n\u2019accepterais jamais de menacer la sant\u00e9 de mes dents pour des raisons esth\u00e9tiques","value":"2","isSelected":false,"price":""},{"text":"Je souhaite uniquement blanchir les dents","value":"3","isSelected":false,"price":""},{"text":"J'accepterais mal d'affaiblir mes dents","value":"4","isSelected":false,"price":""},{"text":"J'accepterais difficilement que de nombreuses s\u00e9ances de soins soient n\u00e9cessaires","value":"5","isSelected":false,"price":""},{"text":"Je suis pr\u00eat(e) \u00e0 faire, ou refaire, des soins ou des proth\u00e8ses pour am\u00e9liorer l'esth\u00e9tique globale de mon sourire","value":"6","isSelected":false,"price":""},{"text":"Je souhaite \u00e9viter l'emploi de m\u00e9taux pour restaurer les dents les plus d\u00e9labr\u00e9es","value":"7","isSelected":false,"price":""},{"text":"J\u2019accepterais, si besoin, un ou des implants si besoin","value":"8","isSelected":false,"price":""},{"text":"J\u2019accepterais, si besoin, qu\u2019une dent soit enlev\u00e9e pour faire de la place et r\u00e9gulariser le sourire","value":"9","isSelected":false,"price":""},{"text":"J\u2019accepterais, si besoin, un traitement pour d\u00e9placer mes dents","value":"11","isSelected":false,"price":""},{"text":"J\u2019aimerais voir \u00e0 l\u2019avance, par des images ou des moulages, le r\u00e9sultat des travaux avant de les entreprendre","value":"12","isSelected":false,"price":""}],"inputs":[{"id":"37.1","label":"Je redoute d\u2019engager de v\u00e9ritables modifications de mes dents","name":""},{"id":"37.2","label":"Je n\u2019accepterais jamais de menacer la sant\u00e9 de mes dents pour des raisons esth\u00e9tiques","name":""},{"id":"37.3","label":"Je souhaite uniquement blanchir les dents","name":""},{"id":"37.4","label":"J'accepterais mal d'affaiblir mes dents","name":""},{"id":"37.5","label":"J'accepterais difficilement que de nombreuses s\u00e9ances de soins soient n\u00e9cessaires","name":""},{"id":"37.6","label":"Je suis pr\u00eat(e) \u00e0 faire, ou refaire, des soins ou des proth\u00e8ses pour am\u00e9liorer l'esth\u00e9tique globale de mon sourire","name":""},{"id":"37.7","label":"Je souhaite \u00e9viter l'emploi de m\u00e9taux pour restaurer les dents les plus d\u00e9labr\u00e9es","name":""},{"id":"37.8","label":"J\u2019accepterais, si besoin, un ou des implants si besoin","name":""},{"id":"37.9","label":"J\u2019accepterais, si besoin, qu\u2019une dent soit enlev\u00e9e pour faire de la place et r\u00e9gulariser le sourire","name":""},{"id":"37.11","label":"J\u2019accepterais, si besoin, un traitement pour d\u00e9placer mes dents","name":""},{"id":"37.12","label":"J\u2019aimerais voir \u00e0 l\u2019avance, par des images ou des moulages, le r\u00e9sultat des travaux avant de les entreprendre","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_info"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":38,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"aesthetic_odf","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Le probl\u00e8me esth\u00e9tique est caus\u00e9 par mes dents de devant mal rang\u00e9es","value":"1","isSelected":false,"price":""},{"text":"Le probl\u00e8me esth\u00e9tique concerne le volume ou la forme de mes gencives","value":"2","isSelected":false,"price":""},{"text":"Certaines de mes dents de devant n\u2019ont jamais pouss\u00e9","value":"3","isSelected":false,"price":""},{"text":"Il y a des espaces disgracieux entre mes dents de devant","value":"4","isSelected":false,"price":""},{"text":"J\u2019ai longtemps suc\u00e9 mon pouce","value":"5","isSelected":false,"price":""},{"text":"J\u2019ai tendance \u00e0 respirer par la bouche","value":"6","isSelected":false,"price":""},{"text":"Mes gencives sont beaucoup trop visibles quand je souris","value":"7","isSelected":false,"price":""},{"text":"Mes dents de devant sont beaucoup trop visibles quand je souris","value":"8","isSelected":false,"price":""},{"text":"On ne voit pas du tout mes dents de devant quand je souris","value":"9","isSelected":false,"price":""},{"text":"Mes dents de devant ne se touchent pas quand je serre les dents","value":"10","isSelected":false,"price":""},{"text":"Mon menton est tr\u00e8s en arri\u00e8re quand je serre les dents","value":"11","isSelected":false,"price":""},{"text":"Mon probl\u00e8me esth\u00e9tique est li\u00e9 au fait que mes dents du bas d\u00e9bordent sur celles du haut","value":"12","isSelected":false,"price":""}],"inputs":[{"id":"38.1","label":"Le probl\u00e8me esth\u00e9tique est caus\u00e9 par mes dents de devant mal rang\u00e9es","name":""},{"id":"38.2","label":"Le probl\u00e8me esth\u00e9tique concerne le volume ou la forme de mes gencives","name":""},{"id":"38.3","label":"Certaines de mes dents de devant n\u2019ont jamais pouss\u00e9","name":""},{"id":"38.4","label":"Il y a des espaces disgracieux entre mes dents de devant","name":""},{"id":"38.5","label":"J\u2019ai longtemps suc\u00e9 mon pouce","name":""},{"id":"38.6","label":"J\u2019ai tendance \u00e0 respirer par la bouche","name":""},{"id":"38.7","label":"Mes gencives sont beaucoup trop visibles quand je souris","name":""},{"id":"38.8","label":"Mes dents de devant sont beaucoup trop visibles quand je souris","name":""},{"id":"38.9","label":"On ne voit pas du tout mes dents de devant quand je souris","name":""},{"id":"38.11","label":"Mes dents de devant ne se touchent pas quand je serre les dents","name":""},{"id":"38.12","label":"Mon menton est tr\u00e8s en arri\u00e8re quand je serre les dents","name":""},{"id":"38.13","label":"Mon probl\u00e8me esth\u00e9tique est li\u00e9 au fait que mes dents du bas d\u00e9bordent sur celles du haut","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_odf"}]},"formId":8,"description":"","inputType":"","cssClass":"aesthetic_odf","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":162,"label":"Parmi les 2 profils ci-dessous, choisissez celui qui correspond le mieux \u00e0 votre situation","adminLabel":"aesthetic_gingiva","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Mes gencives sont trop visibles quand je souris. Mes gencives ne sont pas malades.","value":"gummy_smile","isSelected":false,"price":""},{"text":"Au moins une dent de devant est mobile et des espaces sont apparus avec les voisines. Mes gencives ont d\u00e9j\u00e0 \u00e9t\u00e9 soign\u00e9es.","value":"vers_paro","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"<span class=\"important\">Important : prenez bien le temps de lire l\u2019ensemble des profils avant de faire votre choix<\/span>","enableChoiceValue":true,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"35","operator":"is","value":"aesthetic_gingiva"}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":41,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_checkparo","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Votre probl\u00e8me de gencive est situ\u00e9 au contact de dents recouvertes de d\u00e9bris blanch\u00e2tres (plaque dentaire) ou de tartre","value":"1","isSelected":false,"price":""},{"text":"Votre probl\u00e8me de gencive est situ\u00e9 au contact de dents mal rang\u00e9es ou qui se chevauchent","value":"2","isSelected":false,"price":""},{"text":"Votre probl\u00e8me de gencive se situe au niveau de dents tr\u00e8s serr\u00e9es, naturellement, ou par des soins dentaires","value":"3","isSelected":false,"price":""},{"text":"Votre gencive est plus ou moins gonfl\u00e9e, rouge, et sensible aux endroits atteints au bord des dents","value":"4","isSelected":false,"price":""},{"text":"Les bords de la gencive sont abim\u00e9s et gris\u00e2tres autour de dents de devant","value":"5","isSelected":false,"price":""},{"text":"Votre probl\u00e8me de gencive concerne des dents d\u00e9chauss\u00e9es ou qui bougent","value":"6","isSelected":false,"price":""},{"text":"En plus de probl\u00e8mes gingivaux, vous observez des anomalies sur vos joues, ou vos l\u00e8vres, ou votre langue ou votre palais.","value":"7","isSelected":false,"price":""},{"text":"Vous avez des t\u00e2ches ou des plaques, rouges ou blanches, sur les gencives ou au palais, et qui ne sont pas am\u00e9lior\u00e9es par l\u2019hygi\u00e8ne ou les soins de gencives","value":"8","isSelected":false,"price":""},{"text":"Vous avez des ganglions sous la m\u00e2choire","value":"9","isSelected":false,"price":""},{"text":"Vous avez mauvaise haleine","value":"10","isSelected":false,"price":""},{"text":"Vous \u00eates fatigu\u00e9(e) et \/ ou vous avez de la fi\u00e8vre","value":"11","isSelected":false,"price":""}],"inputs":[{"id":"41.1","label":"Votre probl\u00e8me de gencive est situ\u00e9 au contact de dents recouvertes de d\u00e9bris blanch\u00e2tres (plaque dentaire) ou de tartre","name":""},{"id":"41.2","label":"Votre probl\u00e8me de gencive est situ\u00e9 au contact de dents mal rang\u00e9es ou qui se chevauchent","name":""},{"id":"41.3","label":"Votre probl\u00e8me de gencive se situe au niveau de dents tr\u00e8s serr\u00e9es, naturellement, ou par des soins dentaires","name":""},{"id":"41.4","label":"Votre gencive est plus ou moins gonfl\u00e9e, rouge, et sensible aux endroits atteints au bord des dents","name":""},{"id":"41.5","label":"Les bords de la gencive sont abim\u00e9s et gris\u00e2tres autour de dents de devant","name":""},{"id":"41.6","label":"Votre probl\u00e8me de gencive concerne des dents d\u00e9chauss\u00e9es ou qui bougent","name":""},{"id":"41.7","label":"En plus de probl\u00e8mes gingivaux, vous observez des anomalies sur vos joues, ou vos l\u00e8vres, ou votre langue ou votre palais.","name":""},{"id":"41.8","label":"Vous avez des t\u00e2ches ou des plaques, rouges ou blanches, sur les gencives ou au palais, et qui ne sont pas am\u00e9lior\u00e9es par l\u2019hygi\u00e8ne ou les soins de gencives","name":""},{"id":"41.9","label":"Vous avez des ganglions sous la m\u00e2choire","name":""},{"id":"41.11","label":"Vous avez mauvaise haleine","name":""},{"id":"41.12","label":"Vous \u00eates fatigu\u00e9(e) et \/ ou vous avez de la fi\u00e8vre","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"paro"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":163,"label":"Probl\u00e8me parodontologique?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"content":"[alert type=\"warning\" close=\"false\" heading=\"Probl\u00e8me parodontologique?\"]D'apr\u00e8s vos r\u00e9ponses, il semble que votre probl\u00e8me concerne plut\u00f4t <b>vos gencives.<\/b>\nMerci de revenir en arri\u00e8re et choisir la cat\u00e9gorie <b >Gencives<\/b>.[\/alert]","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"162","operator":"is","value":"vers_paro"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":179,"label":"Langue, joues, l\u00e8vres...","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"40","operator":"is","value":"diapneusie_algo"},{"fieldId":"40","operator":"is","value":"stomatodynies_algo"},{"fieldId":"40","operator":"is","value":"dermato_lichen_algo"},{"fieldId":"40","operator":"is","value":"herpes_algo"},{"fieldId":"40","operator":"is","value":"zona_algo"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":42,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_diapneusie_algo","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"vous pouvez faire bouger la petite boule avec la langue","value":"1","isSelected":false,"price":""},{"text":"la petite boule peut \u00eatre aspir\u00e9e entre deux dents ou sous une proth\u00e8se","value":"2","isSelected":false,"price":""}],"inputs":[{"id":"42.1","label":"vous pouvez faire bouger la petite boule avec la langue","name":""},{"id":"42.2","label":"la petite boule peut \u00eatre aspir\u00e9e entre deux dents ou sous une proth\u00e8se","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"diapneusie_algo"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":211,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_stomatodynies_algo","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Les douleurs diminuent ou disparaissent la nuit","value":"1","isSelected":false,"price":""},{"text":"Je suis inquiet(e) car on ne trouve pas l'origine de la douleur","value":"2","isSelected":false,"price":""}],"inputs":[{"id":"211.1","label":"Les douleurs diminuent ou disparaissent la nuit","name":""},{"id":"211.2","label":"Je suis inquiet(e) car on ne trouve pas l'origine de la douleur","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"stomatodynies_algo"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":43,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_lichen_algo","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Il y a des zones rouges mais pas de zones blanches","value":"1","isSelected":false,"price":""},{"text":"Les zones rouges ne sont visibles que sur les gencives le long des dents","value":"2","isSelected":false,"price":""},{"text":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","value":"3","isSelected":false,"price":""},{"text":"Vous avez une langue rouge et lisse","value":"4","isSelected":false,"price":""},{"text":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","value":"5","isSelected":false,"price":""},{"text":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","value":"6","isSelected":false,"price":""},{"text":"Les zones blanches et \/ ou rouge sont douloureuses","value":"7","isSelected":false,"price":""},{"text":"Il y a des zones blanches mais pas de zones rouges","value":"8","isSelected":false,"price":""},{"text":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","value":"9","isSelected":false,"price":""},{"text":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","value":"10","isSelected":false,"price":""},{"text":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","value":"11","isSelected":false,"price":""},{"text":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","value":"12","isSelected":false,"price":""},{"text":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","value":"13","isSelected":false,"price":""}],"inputs":[{"id":"43.1","label":"Il y a des zones rouges mais pas de zones blanches","name":""},{"id":"43.2","label":"Les zones rouges ne sont visibles que sur les gencives le long des dents","name":""},{"id":"43.3","label":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","name":""},{"id":"43.4","label":"Vous avez une langue rouge et lisse","name":""},{"id":"43.5","label":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","name":""},{"id":"43.6","label":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","name":""},{"id":"43.7","label":"Les zones blanches et \/ ou rouge sont douloureuses","name":""},{"id":"43.8","label":"Il y a des zones blanches mais pas de zones rouges","name":""},{"id":"43.9","label":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","name":""},{"id":"43.11","label":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","name":""},{"id":"43.12","label":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","name":""},{"id":"43.13","label":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","name":""},{"id":"43.14","label":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"dermato_lichen_algo"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":313,"label":"Merci de pr\u00e9ciser la couleur des zones","adminLabel":"dermato_lichen_algo","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Zones blanches seulement","value":"dermato_lichen_algo_white","isSelected":false,"price":""},{"text":"Zones rouges seulement","value":"dermato_lichen_algo_red","isSelected":false,"price":""},{"text":"Zones rouge ET blanches","value":"dermato_lichen_algo_red_and_white","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"dermato_lichen_algo"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":314,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_lichen_algo_white","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","value":"6","isSelected":false,"price":""},{"text":"Les zones blanches sont douloureuses","value":"7","isSelected":false,"price":""},{"text":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","value":"9","isSelected":false,"price":""},{"text":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","value":"10","isSelected":false,"price":""},{"text":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","value":"11","isSelected":false,"price":""},{"text":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","value":"12","isSelected":false,"price":""},{"text":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","value":"13","isSelected":false,"price":""}],"inputs":[{"id":"314.1","label":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","name":""},{"id":"314.2","label":"Les zones blanches sont douloureuses","name":""},{"id":"314.3","label":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","name":""},{"id":"314.4","label":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","name":""},{"id":"314.5","label":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","name":""},{"id":"314.6","label":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","name":""},{"id":"314.7","label":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"313","operator":"is","value":"dermato_lichen_algo_white"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":316,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_lichen_algo_red","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Les zones rouges ne sont visibles que sur les gencives le long des dents","value":"2","isSelected":false,"price":""},{"text":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","value":"3","isSelected":false,"price":""},{"text":"Vous avez une langue rouge et lisse","value":"4","isSelected":false,"price":""},{"text":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","value":"5","isSelected":false,"price":""},{"text":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","value":"6","isSelected":false,"price":""},{"text":"Les zones rouges sont douloureuses","value":"7","isSelected":false,"price":""},{"text":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","value":"13","isSelected":false,"price":""}],"inputs":[{"id":"316.1","label":"Les zones rouges ne sont visibles que sur les gencives le long des dents","name":""},{"id":"316.2","label":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","name":""},{"id":"316.3","label":"Vous avez une langue rouge et lisse","name":""},{"id":"316.4","label":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","name":""},{"id":"316.5","label":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","name":""},{"id":"316.6","label":"Les zones rouges sont douloureuses","name":""},{"id":"316.7","label":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"313","operator":"is","value":"dermato_lichen_algo_red"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":317,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_lichen_algo_red_and_white","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"Les zones rouges ne sont visibles que sur les gencives le long des dents","value":"2","isSelected":false,"price":""},{"text":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","value":"3","isSelected":false,"price":""},{"text":"Vous avez une langue rouge et lisse","value":"4","isSelected":false,"price":""},{"text":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","value":"5","isSelected":false,"price":""},{"text":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","value":"6","isSelected":false,"price":""},{"text":"Les zones blanches et \/ ou rouge sont douloureuses","value":"7","isSelected":false,"price":""},{"text":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","value":"9","isSelected":false,"price":""},{"text":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","value":"10","isSelected":false,"price":""},{"text":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","value":"11","isSelected":false,"price":""},{"text":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","value":"12","isSelected":false,"price":""},{"text":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","value":"13","isSelected":false,"price":""}],"inputs":[{"id":"317.1","label":"Les zones rouges ne sont visibles que sur les gencives le long des dents","name":""},{"id":"317.2","label":"Il y a des zones rouges dans les replis des joues ou \u00e0 d\u2019autres endroits de la bouche","name":""},{"id":"317.3","label":"Vous avez une langue rouge et lisse","name":""},{"id":"317.4","label":"Les gencives qui portent vos proth\u00e8ses amovibles sont rouges","name":""},{"id":"317.5","label":"Vous avez une sensation de cuisson et\/ou vous avez la bouche s\u00e8che","name":""},{"id":"317.6","label":"Les zones blanches et \/ ou rouge sont douloureuses","name":""},{"id":"317.7","label":"Les zones blanch\u00e2tres sont en sur\u00e9paisseur. On ne peut pas les d\u00e9coller","name":""},{"id":"317.8","label":"Les traces blanch\u00e2tres, cr\u00e9meuses, peuvent \u00eatre enlev\u00e9es par grattage","name":""},{"id":"317.9","label":"Il y a des traces blanches des deux cot\u00e9s dans la bouche","name":""},{"id":"317.11","label":"Les traces blanches sont comme un r\u00e9seau fin ou une dentelle","name":""},{"id":"317.12","label":"Vous avez des coupures qui cicatrisent mal dans les coins de la bouche","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"313","operator":"is","value":"dermato_lichen_algo_red_and_white"}]},"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","enableChoiceValue":true,"displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":44,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_herpes_algo","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"Je crois que j\u2019ai d\u00e9j\u00e0 eu ce genre de l\u00e9sions","value":"1","isSelected":false,"price":""},{"text":"J\u2019ai des douleurs aux endroits qui ont \u00e9t\u00e9 touch\u00e9s par les v\u00e9sicules","value":"2","isSelected":false,"price":""}],"inputs":[{"id":"44.1","label":"Je crois que j\u2019ai d\u00e9j\u00e0 eu ce genre de l\u00e9sions","name":""},{"id":"44.2","label":"J\u2019ai des douleurs aux endroits qui ont \u00e9t\u00e9 touch\u00e9s par les v\u00e9sicules","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"herpes_algo"}]},"enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":45,"label":"Cochez les cases qui correspondent pr\u00e9cis\u00e9ment \u00e0 votre situation (seulement celles-l\u00e0)","adminLabel":"dermato_zona_algo","isRequired":false,"size":"medium","errorMessage":"","choices":[{"text":"La situation est tr\u00e8s douloureuse","value":"1","isSelected":false,"price":""},{"text":"Les v\u00e9sicules sur la peau sont remplac\u00e9es par des cro\u00fbtes","value":"2","isSelected":false,"price":""}],"inputs":[{"id":"45.1","label":"La situation est tr\u00e8s douloureuse","name":""},{"id":"45.2","label":"Les v\u00e9sicules sur la peau sont remplac\u00e9es par des cro\u00fbtes","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"40","operator":"is","value":"zona_algo"}]},"enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","id":280,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":"","conditionalLogic":null},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"35","operator":"is","value":"doff_other"},{"fieldId":"59","operator":"is","value":"doff_other"},{"fieldId":"24","operator":"is","value":"doff_other"},{"fieldId":"19","operator":"is","value":"doff_other"},{"fieldId":"40","operator":"is","value":"doff_other"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":281,"label":"Merci de d\u00e9crire votre demande de fa\u00e7on concise","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Il semble que vous n'ayez pas trouv\u00e9 de situation qui vous corresponde dans la liste des propositions pr\u00e9c\u00e9dentes.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"page","id":257,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":"","conditionalLogic":null},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"59","operator":"is","value":"perio_septum"},{"fieldId":"59","operator":"is","value":"teeth_healthy_painful_decay_beg_or_fissure"},{"fieldId":"59","operator":"is","value":"teeth_decay_choice"},{"fieldId":"59","operator":"is","value":"teeth_broken"},{"fieldId":"59","operator":"is","value":"perio_wisdom_teeth"},{"fieldId":"59","operator":"is","value":"teeth_extraction_pain"},{"fieldId":"24","operator":"is","value":"perio_abscess"},{"fieldId":"24","operator":"is","value":"perio_septum"},{"fieldId":"24","operator":"is","value":"perio_fracture"},{"fieldId":"35","operator":"is","value":"aesthetic_minimal"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":258,"label":"Localiser la zone de votre bouche concern\u00e9e","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":259,"label":"En haut ou en bas ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"En haut","value":"En haut","isSelected":false,"price":""},{"text":"En bas","value":"En bas","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_left_third doff_no_clear","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":260,"label":"Sur votre gauche ou votre droite ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Sur ma gauche","value":"Sur ma gauche","isSelected":false,"price":""},{"text":"Sur ma droite","value":"Sur ma droite","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_middle_third doff_no_clear","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":261,"label":"Devant ou dans le fond ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Devant (partie visible lorsque je souris)","value":"Devant (partie visible lorsque je souris)","isSelected":false,"price":""},{"text":"Dans le fond de la bouche","value":"Dans le fond de la bouche","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_right_third doff_no_clear","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","id":200,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":""},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":243,"label":"Bloc HTML","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","content":"[alert type=\"info\" ]La fa\u00e7on dont vous entretenez votre bouche et vos habitudes de consommation (sucres, tabac, alcool\u2026) nous permettent de mieux comprendre et traiter la situation de votre bouche. Merci de nous en faire part en r\u00e9pondant aux points ci dessous.[\/alert]","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"select","id":71,"label":"A quelle fr\u00e9quence brossez-vous vos dents ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"2 \u00e0 3 fois par jour","value":"4","isSelected":false,"price":""},{"text":"1 fois par jour","value":"3","isSelected":false,"price":""},{"text":"quelques fois par semaine","value":"2","isSelected":true,"price":""},{"text":"rarement","value":"1","isSelected":false,"price":""},{"text":"jamais","value":"0","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"Ces informations nous permettent de mieux comprendre votre situation clinique.","formId":8,"inputType":"","cssClass":"gf_left_third doff_no_clear","inputName":"","noDuplicates":false,"defaultValue":"{user:doff_hygiene}","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":72,"label":"Vous utilisez","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Une brosse \u00e0 dents classique","value":"m","isSelected":true,"price":""},{"text":"Une brosse \u00e0 dents \u00e9lectrique","value":"a","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"gf_middle_third doff_no_clear","inputName":"{user:doff_toothbrush}","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":276,"label":"Vous utilisez des brossettes inter-dentaires?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"1","isSelected":false,"price":""},{"text":"Non","value":"0","isSelected":true,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","enableChoiceValue":true,"formId":8,"description":"","inputType":"","cssClass":"gf_right_third doff_no_clear","inputName":"{user:doff_toothbrush}","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"hidden","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"select","id":284,"label":"A quelle fr\u00e9quence utilisez-vous des brossettes inter-dentaires?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"2 \u00e0 3 fois par jour","value":"4","isSelected":false,"price":""},{"text":"1 fois par jour","value":"3","isSelected":false,"price":""},{"text":"quelques fois par semaine","value":"2","isSelected":false,"price":""},{"text":"rarement","value":"1","isSelected":false,"price":""},{"text":"jamais","value":"0","isSelected":true,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","formId":8,"inputType":"","cssClass":"gf_left_third doff_no_clear","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"select","id":304,"label":"Votre derni\u00e8re visite dans un cabinet dentaire date de:","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"choices":[{"text":"moins de 6 mois","value":"1","isSelected":false,"price":""},{"text":"moins d'1 an","value":"2","isSelected":false,"price":""},{"text":"moins de 2 ans","value":"3","isSelected":false,"price":""},{"text":"entre 2 et 5 ans","value":"4","isSelected":true,"price":""},{"text":"plus de 5 ans","value":"5","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"\n","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":54,"label":"Vous consommez...","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"cssClass":"","formId":8,"description":"","inputType":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":89,"label":"...du tabac ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Fumeur","value":"1","isSelected":false,"price":""},{"text":"En cours d'arr\u00eat","value":"-1","isSelected":false,"price":""},{"text":"Ancien fumeur","value":"2","isSelected":false,"price":""},{"text":"Jamais","value":"0","isSelected":true,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"cigarettes, tabac \u00e0 chiquer,...","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":229,"label":"Combien de cigarettes consommez vous par jour ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_inline doff_no_clear gf_left_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"89","operator":"is","value":"1"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"40","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":230,"label":"Depuis combien d'ann\u00e9e fumez-vous \u00e0 ce rythme ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_inline doff_no_clear gf_right_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"89","operator":"is","value":"1"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"60","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":278,"label":"Combien de cigarettes consommiez vous par jour ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_inline doff_no_clear gf_left_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"89","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"40","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":279,"label":"Combien d'ann\u00e9es avez-vous fum\u00e9 \u00e0 ce rythme ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_inline doff_no_clear gf_middle_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"89","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"60","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":285,"label":"Depuis combien d'ann\u00e9es avez-vous stopp\u00e9 votre consommation ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_list_inline doff_no_clear gf_right_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"89","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"40","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":90,"label":"...de l'alcool ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Toutes les semaines","value":"2","isSelected":false,"price":""},{"text":"Jamais \/ moins d'une fois par semaine","value":"0","isSelected":true,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"ap\u00e9ritifs, vins, bi\u00e8re, wiskhy,...","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":231,"label":"A quelle fr\u00e9quence vous arrive-t-il de consommer des boissons alcoolis\u00e9es par semaine ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"indiquez le nombre de jours o\u00f9 vous consommez","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"90","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"7","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":232,"label":"Combien de verres standards buvez-vous au cours d'une journ\u00e9e ordinaire o\u00f9 vous consommez de l'alcool ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"90","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"15","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":91,"label":"...des aliments sucr\u00e9s ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Toutes les semaines","value":"2","isSelected":false,"price":""},{"text":"Jamais \/ moins d'une fois par semaine","value":"0","isSelected":true,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"boissons sucr\u00e9es : sodas (colas, ice tea,...), jus d'oranges,... gateaux, bonbons, chocolat, confiture...","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","enableChoiceValue":true,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":233,"label":"A quelle fr\u00e9quence vous arrive-t-il de consommer des aliments sucr\u00e9s par semaine ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"indiquez le nombre de jours par semaine o\u00f9 vous consommez","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"91","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"7","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":234,"label":"Combien d'aliments sucr\u00e9s consommez-vous au cours d'une de ces journ\u00e9es ?","adminLabel":"","isRequired":true,"size":"small","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"91","operator":"is","value":"2"}]},"enableCalculation":false,"rangeMin":"1","rangeMax":"15","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":203,"label":"Informations sur votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"Glisser le curseur \u00e0 gauche ou \u00e0 droite pour refl\u00e9ter la r\u00e9ponse la plus juste aux questions pos\u00e9es","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"slider","id":321,"label":"Evaluer la sant\u00e9 de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","numberFormat":"decimal_dot","rangeMin":0,"rangeMax":10,"slider_step":1,"slider_value_visibility":"hidden","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","inputs":"","choices":"","conditionalLogic":"","productField":"","slider_min_value_relation":"tr\u00e8s mauvaise","slider_max_value_relation":"excellente","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"slider","id":322,"label":"Evaluer le confort de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","numberFormat":"decimal_dot","rangeMin":0,"rangeMax":10,"slider_step":1,"slider_value_visibility":"hidden","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","inputs":"","choices":"","conditionalLogic":"","productField":"","slider_min_value_relation":"tr\u00e8s mauvais","slider_max_value_relation":"excellent","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"slider","id":323,"label":"Evaluer l'esth\u00e9tique de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","numberFormat":"decimal_dot","rangeMin":0,"rangeMax":10,"slider_step":1,"slider_value_visibility":"hidden","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","inputs":"","choices":"","conditionalLogic":"","productField":"","slider_min_value_relation":"tr\u00e8s d\u00e9favorable","slider_max_value_relation":"tr\u00e8s favorable","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":235,"label":"Evaluer la sant\u00e9 de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"0 : tr\u00e8s mauvaise\n10 : excellente","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_third","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","enableCalculation":false,"rangeMin":"0","rangeMax":"10","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":236,"label":"Evaluer le confort de votre bouche","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"0 : tr\u00e8s mauvais\n10 : excellent","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_middle_third","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","enableCalculation":false,"rangeMin":"0","rangeMax":"10","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":237,"label":"Evaluer l'esth\u00e9tique de votre sourire","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"0 : tr\u00e8s d\u00e9favorable\n10 : tr\u00e8s favorable","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_third","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","enableCalculation":false,"rangeMin":"0","rangeMax":"10","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"fileupload","id":202,"label":"Une photo de votre sourire :)","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","maxFileSize":"","maxFiles":"","multipleFiles":false,"allowedExtensions":"","productField":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","id":286,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":""},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":287,"label":"Situation personnelle","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"cssClass":"","formId":8,"description":"","inputType":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"select","id":288,"label":"Situation d'emploi","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"","value":"","isSelected":false,"price":""},{"text":"occupe un emploi","value":"occupe un emploi","isSelected":false,"price":""},{"text":"au chomage","value":"au chomage","isSelected":false,"price":""},{"text":"pr\u00e9-retraite, retraite ou retir\u00e9 des affaires","value":"pr\u00e9-retraite, retraite ou retir\u00e9 des affaires","isSelected":false,"price":""},{"text":"autre situation (personne sans activit\u00e9 professionnelle et non retrait\u00e9)","value":"autre situation (personne sans activit\u00e9 professionnelle et non retrait\u00e9)","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":302,"label":"Merci de pr\u00e9ciser lequel:","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_half","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"288","operator":"is","value":"occupe un emploi"}]},"productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"select","id":289,"label":"Situation de famille","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"","value":"","isSelected":false,"price":""},{"text":"c\u00e9libataire","value":"c\u00e9libataire","isSelected":false,"price":""},{"text":"concubinage","value":"concubinage","isSelected":false,"price":""},{"text":"mari\u00e9(e)","value":"mari\u00e9(e)","isSelected":false,"price":""},{"text":"pacs\u00e9(e)","value":"pacs\u00e9(e)","isSelected":false,"price":""},{"text":"divorc\u00e9(e)","value":"divorc\u00e9(e)","isSelected":false,"price":""},{"text":"veuf(ve)","value":"veuf(ve)","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"number","id":290,"label":"Combien d'enfants avez-vous ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"numberFormat":"decimal_dot","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_middle_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","enableCalculation":false,"rangeMin":"0","rangeMax":"20","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":293,"label":"Votre m\u00e9decin habituel","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":292,"label":"Son nom complet","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_left_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"text","id":318,"label":"Son code postal","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_middle_third","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"phone","id":294,"label":"Son num\u00e9ro de t\u00e9l\u00e9phone","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"phoneFormat":"international","formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","form_id":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"page","adminLabel":"","allowsPrepopulate":false,"choices":"","conditionalLogic":"","cssClass":"","defaultValue":"","description":"","descriptionPlacement":"","displayOnly":true,"errorMessage":"","formId":8,"id":117,"inputMask":false,"inputMaskValue":"","inputName":"","inputType":"","inputs":null,"isRequired":false,"label":"","labelPlacement":"","nextButton":{"imageUrl":"","text":"Suivant","type":"text","conditionalLogic":null},"noDuplicates":false,"placeholder":"","previousButton":{"imageUrl":"","text":"Pr\u00e9c\u00e9dent","type":"text"},"size":"medium","subLabelPlacement":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":241,"label":"practitioner feedback","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"67","operator":"isnot","value":""}]},"content":"[alert type=\"info\" close=\"false\" heading=\"Le praticien a besoin d'informations sur votre sant\u00e9 g\u00e9n\u00e9rale\"]Nous vous rappelons que toutes vos donn\u00e9es sont s\u00e9curis\u00e9es chez un h\u00e9bergeur agr\u00e9\u00e9 par l'\u00e9tat et respectent le secret m\u00e9dical.[\/alert]","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":291,"label":"Etes-vous enceinte ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"y","isSelected":false,"price":""},{"text":"Non","value":"n","isSelected":false,"price":""},{"text":"Peut-\u00eatre","value":"maybe","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"doff_no_clear gf_right_third","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"2","operator":"is","value":"f"}]},"productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableChoiceValue":true,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":239,"label":"Pouvez-vous nous pr\u00e9ciser des informations sur votre sant\u00e9 g\u00e9n\u00e9rale","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Oui","value":"both","isSelected":false,"price":""},{"text":"Non","value":"checkup","isSelected":false,"price":""}],"formId":8,"description":"Ceci est tr\u00e8s important pour le praticien qui va vous prendre en charge et permet d'am\u00e9liorer la pertinence des r\u00e9sultats qui vous seront d\u00e9livr\u00e9s","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"doff_restriction","visibility":"hidden","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"enableChoiceValue":true,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":68,"label":"Ant\u00e9c\u00e9dents","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"cssClass":"","formId":8,"description":"","inputType":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":212,"label":"Vous souffrez d'une Affection de Longue Dur\u00e9e (ALD) ?","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Non","value":"non","isSelected":true,"price":""},{"text":"Oui : ALD 15 (<a target=\"_blank\" href=\"https:\/\/www.has-sante.fr\/portail\/jcms\/c_820000\/fr\/ald-n-15-maladie-d-alzheimer-et-autres-demences\">Maladie d'Alzheimer et autres d\u00e9mences<\/a>)","value":"ald15","isSelected":false,"price":""},{"text":"Oui : ALD 23 (<a target=\"_blank\" href=\"https:\/\/www.has-sante.fr\/portail\/upload\/docs\/application\/pdf\/2010-11\/troubles_depression_web.pdf\">Trouble d\u00e9pressif r\u00e9current ou persistant<\/a>)","value":"ald23","isSelected":false,"price":""},{"text":"Oui : ALD 30 (cliquer pour voir apparaitre la liste ci dessous)","value":"ald30","isSelected":false,"price":""},{"text":"Oui : ALD 31 (Les affections dites \u00ab hors liste \u00bb)","value":"ald31","isSelected":false,"price":""},{"text":"Oui : ALD 32 (Polypathologies)","value":"ald32","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"enableChoiceValue":true,"inputName":"{user:doff_ald}","conditionalLogic":"","formId":8,"description":"<a target=\"_blank\" href=\"http:\/\/www.ameli.fr\/assures\/droits-et-demarches\/par-situation-medicale\/vous-souffrez-d-une-affection-de-longue-duree\/qu-est-ce-qu-une-affection-de-longue-duree-ald.php\">Qu'est ce qu'une ALD ?<\/a>","inputType":"","cssClass":"","noDuplicates":false,"defaultValue":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"select","id":226,"label":"ALD 30","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Accident vasculaire c\u00e9r\u00e9bral invalidant","value":"Accident vasculaire c\u00e9r\u00e9bral invalidant","isSelected":false,"price":""},{"text":"Insuffisances m\u00e9dullaires et autres cytop\u00e9nies chroniques","value":"Insuffisances m\u00e9dullaires et autres cytop\u00e9nies chroniques","isSelected":false,"price":""},{"text":"Art\u00e9riopathies chroniques avec manifestations isch\u00e9miques","value":"Art\u00e9riopathies chroniques avec manifestations isch\u00e9miques","isSelected":false,"price":""},{"text":"Bilharziose compliqu\u00e9e","value":"Bilharziose compliqu\u00e9e","isSelected":false,"price":""},{"text":"Insuffisance cardiaque grave, troubles du rythme graves, cardiopathies valvulaires graves, cardiopathies cong\u00e9nitales graves","value":"Insuffisance cardiaque grave, troubles du rythme graves, cardiopathies valvulaires graves, cardiopathies cong\u00e9nitales graves","isSelected":false,"price":""},{"text":"Maladies chroniques actives du foie et cirrhoses","value":"Maladies chroniques actives du foie et cirrhoses","isSelected":false,"price":""},{"text":"D\u00e9ficit immunitaire primitif grave n\u00e9cessitant un traitement prolong\u00e9, infection par le Virus de l'immunod\u00e9ficience humaine (VIH)","value":"D\u00e9ficit immunitaire primitif grave n\u00e9cessitant un traitement prolong\u00e9, infection par le Virus de l'immunod\u00e9ficience humaine (VIH)","isSelected":false,"price":""},{"text":"Diab\u00e8te de type 1 et diab\u00e8te de type 2","value":"Diab\u00e8te de type 1 et diab\u00e8te de type 2","isSelected":false,"price":""},{"text":"Formes graves des affections neurologiques et musculaires (dont myopathie et \u00e9pilepsie grave)","value":"Formes graves des affections neurologiques et musculaires (dont myopathie et \u00e9pilepsie grave)","isSelected":false,"price":""},{"text":"H\u00e9moglobinopathies, h\u00e9molyses, chroniques constitutionnelles et acquises s\u00e9v\u00e8res","value":"H\u00e9moglobinopathies, h\u00e9molyses, chroniques constitutionnelles et acquises s\u00e9v\u00e8res","isSelected":false,"price":""},{"text":"H\u00e9mophilies et affections constitutionnelles de l'h\u00e9mostase graves","value":"H\u00e9mophilies et affections constitutionnelles de l'h\u00e9mostase graves","isSelected":false,"price":""},{"text":"Maladie coronaire","value":"Maladie coronaire","isSelected":false,"price":""},{"text":"Insuffisance respiratoire chronique grave (dont BPCO)","value":"Insuffisance respiratoire chronique grave (dont BPCO)","isSelected":false,"price":""},{"text":"Maladie d'Alzheimer et autres d\u00e9mences","value":"Maladie d'Alzheimer et autres d\u00e9mences","isSelected":false,"price":""},{"text":"Maladie de Parkinson","value":"Maladie de Parkinson","isSelected":false,"price":""},{"text":"Maladies m\u00e9taboliques h\u00e9r\u00e9ditaires n\u00e9cessitant un traitement prolong\u00e9 sp\u00e9cialis\u00e9","value":"Maladies m\u00e9taboliques h\u00e9r\u00e9ditaires n\u00e9cessitant un traitement prolong\u00e9 sp\u00e9cialis\u00e9","isSelected":false,"price":""},{"text":"Mucoviscidose","value":"Mucoviscidose","isSelected":false,"price":""},{"text":"N\u00e9phropathie chronique grave et syndrome n\u00e9phrotique primitif","value":"N\u00e9phropathie chronique grave et syndrome n\u00e9phrotique primitif","isSelected":false,"price":""},{"text":"Parapl\u00e9gie","value":"Parapl\u00e9gie","isSelected":false,"price":""},{"text":"Vascularites, lupus \u00e9ryth\u00e9mateux syst\u00e9mique, scl\u00e9rodermie syst\u00e9mique","value":"Vascularites, lupus \u00e9ryth\u00e9mateux syst\u00e9mique, scl\u00e9rodermie syst\u00e9mique","isSelected":false,"price":""},{"text":"Polyarthrite rhumato\u00efde \u00e9volutive","value":"Polyarthrite rhumato\u00efde \u00e9volutive","isSelected":false,"price":""},{"text":"Affections psychiatriques de longue dur\u00e9e (dont bipolaire 1 et 2 et trouble de la personnalit\u00e9)","value":"Affections psychiatriques de longue dur\u00e9e (dont bipolaire 1 et 2 et trouble de la personnalit\u00e9)","isSelected":false,"price":""},{"text":"Rectocolite h\u00e9morragique et maladie de Crohn \u00e9volutives","value":"Rectocolite h\u00e9morragique et maladie de Crohn \u00e9volutives","isSelected":false,"price":""},{"text":"Scl\u00e9rose en plaques","value":"Scl\u00e9rose en plaques","isSelected":false,"price":""},{"text":"Scoliose idiopathique structurale \u00e9volutive (dont l'angle est \u00e9gal ou sup\u00e9rieur \u00e0 25 degr\u00e9s) jusqu'\u00e0 maturation rachidienne","value":"Scoliose idiopathique structurale \u00e9volutive (dont l'angle est \u00e9gal ou sup\u00e9rieur \u00e0 25 degr\u00e9s) jusqu'\u00e0 maturation rachidienne","isSelected":false,"price":""},{"text":"Spondylarthrite grave","value":"Spondylarthrite grave","isSelected":false,"price":""},{"text":"Suites de transplantation d'organe","value":"Suites de transplantation d'organe","isSelected":false,"price":""},{"text":"Tuberculose active (dont l\u00e8pre)","value":"Tuberculose active (dont l\u00e8pre)","isSelected":false,"price":""},{"text":"Tumeur maligne, affection maligne du tissu lymphatique ou h\u00e9matopo\u00ef\u00e9tique","value":"Tumeur maligne, affection maligne du tissu lymphatique ou h\u00e9matopo\u00ef\u00e9tique","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"212","operator":"is","value":"ald30"}]},"productField":"","enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":214,"label":"ALD31 : Pr\u00e9ciser","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Elles concernent les patients atteints d'une forme grave d'une maladie, ou d'une forme \u00e9volutive ou invalidante d'une maladie grave, ne figurant pas sur la liste des ALD 30. Elles comportent un traitement prolong\u00e9 d'une dur\u00e9e pr\u00e9visible sup\u00e9rieure \u00e0 six mois et une th\u00e9rapeutique particuli\u00e8rement co\u00fbteuse.\nEx. : maladie de Paget, les ulc\u00e8res chroniques ou r\u00e9cidivants avec retentissement fonctionnel s\u00e9v\u00e8re.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"212","operator":"is","value":"ald31"}]},"productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"text","id":215,"label":"Les polypathologies (ALD 32) : Pr\u00e9ciser","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Le terme \"polypathologies\" est employ\u00e9 pour les patients atteint de plusieurs affections caract\u00e9ris\u00e9es, entra\u00eenant un \u00e9tat pathologique invalidant et n\u00e9cessitant des soins continus d'une dur\u00e9e pr\u00e9visible sup\u00e9rieure \u00e0 six mois.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"212","operator":"is","value":"ald32"}]},"productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"checkbox","adminLabel":"","allowsPrepopulate":true,"calculationFormula":"","calculationRounding":"","choices":[{"isSelected":false,"price":"","text":"Migraines ou c\u00e9phal\u00e9es","value":"headache"},{"isSelected":false,"price":"","text":"Hypertension \/ trouble du rythme","value":"heart"},{"isSelected":false,"price":"","text":"Probl\u00e8mes sanguins","value":"blood"},{"isSelected":false,"price":"","text":"Probl\u00e8mes infectieux","value":"infection"},{"isSelected":false,"price":"","text":"Maladie respiratoire","value":"breath"},{"isSelected":false,"price":"","text":"Maladie digestive","value":"digestive"},{"isSelected":false,"price":"","text":"Maladie uro-g\u00e9nitale","value":"uro"},{"isSelected":false,"price":"","text":"Maladie neurologique","value":"neuro"},{"text":"Stress \/ Anxi\u00e9t\u00e9","value":"stress","isSelected":false,"price":""},{"text":"Douleurs chroniques","value":"chronical_pain","isSelected":false,"price":""},{"isSelected":false,"price":"","text":"D\u00e9pression","value":"depression"},{"isSelected":false,"price":"","text":"Probl\u00e8mes psychologiques","value":"psy"},{"isSelected":false,"price":"","text":"Probl\u00e8mes hormonaux","value":"hormonal"},{"isSelected":false,"price":"","text":"Allergies, asthme","value":"allergy"},{"isSelected":false,"price":"","text":"Probl\u00e8mes ORL","value":"orl"},{"isSelected":false,"price":"","text":"Maladie rhumatismale","value":"rhumatisme"},{"isSelected":false,"price":"","text":"Traumatismes ou des accidents","value":"trauma"},{"isSelected":false,"price":"","text":"Intervention(s) chirurgicale(s)","value":"several_surgery"},{"isSelected":false,"price":"","text":"Diab\u00e8te","value":"diabete"},{"text":"Traitement par immunosuppresseurs","value":"immuno","isSelected":false,"price":""},{"text":"Ost\u00e9oporose trait\u00e9e par les diphosphonates","value":"osteo","isSelected":false,"price":""},{"text":"Toxicomanie","value":"toxico","isSelected":false,"price":""},{"isSelected":false,"price":"","text":"Autre maladie chronique","value":"other"}],"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"212","operator":"is","value":"non"}]},"cssClass":"gf_list_2col","defaultValue":"","description":"maladies, allergies, op\u00e9rations","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","enableCalculation":"","errorMessage":"","formId":8,"id":9,"inputMask":false,"inputMaskValue":"","inputName":"{user:doff_general_diseases}","inputType":"","inputs":[{"id":"9.1","label":"Migraines ou c\u00e9phal\u00e9es","name":""},{"id":"9.2","label":"Hypertension \/ trouble du rythme","name":""},{"id":"9.3","label":"Probl\u00e8mes sanguins","name":""},{"id":"9.4","label":"Probl\u00e8mes infectieux","name":""},{"id":"9.5","label":"Maladie respiratoire","name":""},{"id":"9.6","label":"Maladie digestive","name":""},{"id":"9.7","label":"Maladie uro-g\u00e9nitale","name":""},{"id":"9.8","label":"Maladie neurologique","name":""},{"id":"9.9","label":"Stress \/ Anxi\u00e9t\u00e9","name":""},{"id":"9.11","label":"Douleurs chroniques","name":""},{"id":"9.12","label":"D\u00e9pression","name":""},{"id":"9.13","label":"Probl\u00e8mes psychologiques","name":""},{"id":"9.14","label":"Probl\u00e8mes hormonaux","name":""},{"id":"9.15","label":"Allergies, asthme","name":""},{"id":"9.16","label":"Probl\u00e8mes ORL","name":""},{"id":"9.17","label":"Maladie rhumatismale","name":""},{"id":"9.18","label":"Traumatismes ou des accidents","name":""},{"id":"9.19","label":"Intervention(s) chirurgicale(s)","name":""},{"id":"9.21","label":"Diab\u00e8te","name":""},{"id":"9.22","label":"Traitement par immunosuppresseurs","name":""},{"id":"9.23","label":"Ost\u00e9oporose trait\u00e9e par les diphosphonates","name":""},{"id":"9.24","label":"Toxicomanie","name":""},{"id":"9.25","label":"Autre maladie chronique","name":""}],"isRequired":false,"label":"Vous ne souffrez pas d'ALD, cochez les situations qui vous concernent:","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","enableChoiceValue":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"list","id":332,"label":"Pr\u00e9ciser les interventions chirurgicales","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"9","operator":"is","value":"several_surgery"}]},"maxRows":0,"productField":"","itsg_list_field_drop_down":"","itsg_list_field_drop_down_enhanced":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","enableColumns":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":244,"label":"Souffrez vous d'un handicap particulier?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Merci de l'indiquer dans la case ci-dessous le cas \u00e9ch\u00e9ant","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"section","id":249,"label":"M\u00e9dicaments","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":250,"label":"Si vous \u00eates allergique \u00e0 un m\u00e9dicament, ou avez d\u00e9j\u00e0 eu des accidents avec des m\u00e9dicaments, notez le ici:","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","inputMaskIsCustom":""},{"type":"list","id":216,"label":"Si vous avez des traitements m\u00e9dicamenteux en cours:","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Merci d'inscrire ci-dessous leurs noms, tels que figurant sur votre ordonnance (sans la posologie). Cliquer le + pour ajouter une ligne, et sur - pour supprimer la ligne.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","maxRows":0,"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","itsg_list_field_dropdown":"","itsg_list_field_drop_down":"","enableColumns":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"fileupload","id":262,"label":"Sinon, prenez une photo de votre (ou vos) ordonnance:","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Vous pouvez aussi scanner celle(s)-ci","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","maxFileSize":15,"maxFiles":"3","multipleFiles":true,"allowedExtensions":"","productField":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":false},{"type":"section","id":320,"label":"Radiographies","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"fileupload","id":319,"label":"Radiographies dentaires","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"Vous pouvez ajouter si vous le souhaitez des radiographies qui nous permettront d'anticiper la situation clinique avec beaucoup plus de pertinence.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","maxFileSize":15,"maxFiles":"3","multipleFiles":true,"allowedExtensions":"","productField":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":false},{"type":"page","id":201,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":""},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":55,"label":"Vos r\u00e9sultats","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"hidden","id":134,"label":"userid","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"defaultValue":"{user:user_email}","formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"choices":"","conditionalLogic":"","displayOnly":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":133,"label":"D\u00e9j\u00e0 un compte ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"content":"[doff_checkup_connection_message sender=doff_sender_user_id patient_email=doff_patient_email]","formId":8,"description":"","inputType":"","cssClass":"doff_no_clear","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"email","adminLabel":"","allowsPrepopulate":true,"calculationFormula":"","calculationRounding":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"134","operator":"is","value":""}]},"cssClass":"doff_no_clear","defaultValue":"","description":"Nous enverrons vos r\u00e9sultats \u00e0 l'adresse e-mail fournie, imm\u00e9diatement apr\u00e8s avoir valid\u00e9 le formulaire. Cette adresse doit \u00eatre priv\u00e9e et consultable uniquement par vous.","descriptionPlacement":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","emailConfirmEnabled":true,"enableCalculation":"","errorMessage":"","formId":8,"id":4,"inputMask":false,"inputMaskValue":"","inputName":"doff_patient_email","inputType":"","inputs":[{"id":"4","label":"Saisissez un e-mail","name":"","customLabel":"Votre email priv\u00e9"},{"id":"4.2","label":"Confirmez l\u2019e-mail","name":""}],"isRequired":false,"label":"Cr\u00e9er un compte","labelPlacement":"","maxFiles":"","multipleFiles":false,"noDuplicates":false,"placeholder":"","size":"medium","subLabelPlacement":"","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":69,"label":"Souhaitez-vous","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Faire parvenir ces r\u00e9sultats \u00e0 mon praticien","value":"my_practitioner","isSelected":true,"price":""},{"text":"Garder ces infomations pour moi seul","value":"solo","isSelected":false,"price":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","formId":8,"description":"Dans tous les cas, vos informations restent confidentielles et ne sont en aucun cas transmises \u00e0 un tiers","inputType":"","cssClass":"","inputName":"doff_forward_to_practitioner","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"277","operator":"is","value":""}]},"displayOnly":"","enableChoiceValue":true,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":77,"label":"Envoyer les r\u00e9sultats \u00e0 mon praticien","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"69","operator":"is","value":"my_practitioner"},{"fieldId":"277","operator":"isnot","value":""}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"name","id":74,"label":"Votre nom complet","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","nameFormat":"advanced","inputs":[{"id":"74.2","label":"Pr\u00e9fixe","name":"","choices":[{"text":"Mr.","value":"Mr.","isSelected":false,"price":""},{"text":"Mrs.","value":"Mrs.","isSelected":false,"price":""},{"text":"Miss","value":"Miss","isSelected":false,"price":""},{"text":"Ms.","value":"Ms.","isSelected":false,"price":""},{"text":"Dr.","value":"Dr.","isSelected":false,"price":""},{"text":"Prof.","value":"Prof.","isSelected":false,"price":""},{"text":"Rev.","value":"Rev.","isSelected":false,"price":""}],"isHidden":true,"inputType":"radio"},{"id":"74.3","label":"Pr\u00e9nom","name":"doff_patient_firstname","defaultValue":"{user:first_name}"},{"id":"74.4","label":"Middle","name":"","isHidden":true},{"id":"74.6","label":"Nom","name":"doff_patient_lastname","defaultValue":"{user:last_name}"},{"id":"74.8","label":"Suffixe","name":"","isHidden":true}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","conditionalLogic":"","formId":8,"description":"Ceci est indispensable \u00e0 votre praticien pour vous identifier correctement","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"phone","id":264,"label":"Votre t\u00e9l\u00e9phone mobile","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"phoneFormat":"international","formId":8,"description":"Il ne sera en aucun cas partag\u00e9 avec un tiers et vous ne recevrez que les informations n\u00e9cessaires relatives \u00e0 notre service.","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_left_third doff_no_clear","inputName":"doff_patient_phone","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","form_id":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":false},{"type":"phone","id":265,"label":"Votre t\u00e9l\u00e9phone fixe","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"phoneFormat":"international","formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_middle_third doff_no_clear","inputName":"doff_landline_phone","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","form_id":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"phone","id":266,"label":"Votre t\u00e9l\u00e9phone professionnel","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"phoneFormat":"international","formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"gf_right_third doff_no_clear","inputName":"doff_pro_phone","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","form_id":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"address","id":267,"label":"Votre adresse postale","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","addressType":"international","inputs":[{"id":"267.1","label":"Adresse postale","name":"doff_address","defaultValue":""},{"id":"267.2","label":"Adresse ligne 2","name":"doff_address_2","defaultValue":""},{"id":"267.3","label":"Ville","name":"doff_city","defaultValue":""},{"id":"267.4","label":"\u00c9tat \/ Province","name":"","isHidden":true,"defaultValue":""},{"id":"267.5","label":"ZIP \/ Code postal","name":"doff_postcode","defaultValue":""},{"id":"267.6","label":"Pays","name":"doff_country","defaultValue":""}],"formId":8,"description":"","allowsPrepopulate":true,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","defaultCountry":"France","defaultProvince":"","productField":"","defaultState":"","enableCopyValuesOption":"","copyValuesOptionDefault":"","copyValuesOptionLabel":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"id":334,"label":"Votre adresse postale","adminLabel":"","type":"places-api","isRequired":true,"size":"medium","errorMessage":"","visibility":"visible","formId":8,"description":"Commencer \u00e0 taper quelques caract\u00e8res, nous nous chargerons de trouver l'adresse compl\u00e8te.","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","inputs":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":335,"label":"GPlaces Country","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"country","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":336,"label":"GPlaces ZipCode","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"postal_code","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":337,"label":"GPlaces Region","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"administrative_area_level_1","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":338,"label":"GPlaces Area","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"administrative_area_level_2","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":339,"label":"GPlaces City","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"locality","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":340,"label":"GPlaces Route","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"route","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":341,"label":"GPlaces Street Number","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"street_number","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"hidden","id":342,"label":"GPlaces Floor","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","visibility":"visible","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","maxLength":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"geoFieldId":"334","geoField":"floor","fields":"","displayOnly":"","inputMaskIsCustom":""},{"type":"email","id":76,"label":"Email de votre praticien","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":[{"id":"76","label":"Entrer un email","name":"","defaultValue":"{user:doff_practitioner_contacts}"},{"id":"76.2","label":"Confirmer l&#039;email","name":"","defaultValue":"{user:doff_practitioner_contacts}"}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":true,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","conditionalLogic":{"actionType":"hide","logicType":"all","rules":[{"fieldId":"242","operator":">","value":"1"}]},"formId":8,"description":"Vos r\u00e9sultats lui seront transmis de fa\u00e7on confidentielle, et uniquement \u00e0 lui","inputType":"","cssClass":"readonly","inputName":"doff_practitioner_email","noDuplicates":false,"defaultValue":"","choices":"","displayOnly":"","emailConfirmEnabled":true,"visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":268,"label":"Comment avez-vous d\u00e9couvert notre cabinet?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"any","rules":[{"fieldId":"69","operator":"is","value":"my_practitioner"},{"fieldId":"277","operator":"isnot","value":""}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":269,"label":"Par quel m\u00e9dia avez-vous choisi notre cabinet?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"En voyant la plaque professionnelle dans la rue","value":"En voyant la plaque professionnelle dans la rue","isSelected":false,"price":""},{"text":"De bouche \u00e0 oreille","value":"De bouche \u00e0 oreille","isSelected":false,"price":""},{"text":"Adress\u00e9 par un praticien","value":"Adress\u00e9 par un praticien","isSelected":false,"price":""},{"text":"Internet","value":"Internet","isSelected":false,"price":""},{"text":"Annuaire t\u00e9l\u00e9phonique papier","value":"Annuaire t\u00e9l\u00e9phonique papier","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":"","productField":"","enableOtherChoice":true,"enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":275,"label":"Depuis quel site web ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Le site web du cabinet dentaire","value":"Le site web du cabinet dentaire","isSelected":false,"price":""},{"text":"Doctolib.fr","value":"Doctolib.fr","isSelected":false,"price":""},{"text":"Doctoralia.fr","value":"Doctoralia.fr","isSelected":false,"price":""},{"text":"MonDocteur.fr","value":"MonDocteur.fr","isSelected":false,"price":""},{"text":"LeMedecin.fr","value":"LeMedecin.fr","isSelected":false,"price":""},{"text":"PagesJaunes.fr","value":"PagesJaunes.fr","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"269","operator":"is","value":"Internet"}]},"productField":"","enableOtherChoice":true,"enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":270,"label":"Pouvez-vous pr\u00e9ciser de qui il s'agit?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Un patient du cabinet","value":"Un patient du cabinet","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"269","operator":"is","value":"De bouche \u00e0 oreille"}]},"productField":"","enableOtherChoice":true,"enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":271,"label":"Quelle est la profession de ce praticien ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"Dentiste","value":"Dentiste","isSelected":false,"price":""},{"text":"M\u00e9decin","value":"M\u00e9decin","isSelected":false,"price":""},{"text":"Kin\u00e9sith\u00e9rapeute","value":"Kin\u00e9sith\u00e9rapeute","isSelected":false,"price":""},{"text":"Osth\u00e9opathe","value":"Osth\u00e9opathe","isSelected":false,"price":""},{"text":"Pharmacien","value":"Pharmacien","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"269","operator":"is","value":"Adress\u00e9 par un praticien"}]},"productField":"","enableOtherChoice":true,"enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"radio","id":272,"label":"Pouvez-vous pr\u00e9ciser?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"choices":[{"text":"M\u00e9decin traitant","value":"M\u00e9decin traitant","isSelected":false,"price":""},{"text":"M\u00e9decin scolaire","value":"M\u00e9decin scolaire","isSelected":false,"price":""},{"text":"Chirurgien","value":"Chirurgien","isSelected":false,"price":""},{"text":"Cardiologue","value":"Cardiologue","isSelected":false,"price":""},{"text":"ORL","value":"ORL","isSelected":false,"price":""}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"271","operator":"is","value":"M\u00e9decin"}]},"productField":"","enableOtherChoice":true,"enablePrice":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"name","id":273,"label":"Quel est le nom de ce praticien ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","nameFormat":"advanced","inputs":[{"id":"273.2","label":"Pr\u00e9fixe","name":"","choices":[{"text":"M.","value":"M.","isSelected":false,"price":""},{"text":"Mme","value":"Mme","isSelected":false,"price":""},{"text":"Mlle","value":"Mlle","isSelected":false,"price":""},{"text":"Mlle","value":"Mlle","isSelected":false,"price":""},{"text":"Dr","value":"Dr","isSelected":false,"price":""},{"text":"Prof.","value":"Prof.","isSelected":false,"price":""},{"text":"Rev.","value":"Rev.","isSelected":false,"price":""}],"isHidden":true,"inputType":"radio"},{"id":"273.3","label":"Pr\u00e9nom","name":""},{"id":"273.4","label":"2\u00e8me pr\u00e9nom","name":"","isHidden":true},{"id":"273.6","label":"Nom","name":""},{"id":"273.8","label":"Suffixe","name":"","isHidden":true}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"269","operator":"is","value":"Adress\u00e9 par un praticien"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"name","id":274,"label":"Quel est le nom de ce patient ?","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","nameFormat":"advanced","inputs":[{"id":"274.2","label":"Pr\u00e9fixe","name":"","choices":[{"text":"M.","value":"M.","isSelected":false,"price":""},{"text":"Mme","value":"Mme","isSelected":false,"price":""},{"text":"Mlle","value":"Mlle","isSelected":false,"price":""},{"text":"Mlle","value":"Mlle","isSelected":false,"price":""},{"text":"Dr","value":"Dr","isSelected":false,"price":""},{"text":"Prof.","value":"Prof.","isSelected":false,"price":""},{"text":"Rev.","value":"Rev.","isSelected":false,"price":""}],"isHidden":true,"inputType":"radio"},{"id":"274.3","label":"Pr\u00e9nom","name":""},{"id":"274.4","label":"2\u00e8me pr\u00e9nom","name":"","isHidden":true},{"id":"274.6","label":"Nom","name":""},{"id":"274.8","label":"Suffixe","name":"","isHidden":true}],"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"270","operator":"is","value":"Un patient du cabinet"}]},"productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"html","id":248,"label":"Bloc HTML","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","content":"Vos informations confidentielles (et s\u00e9curis\u00e9es) seront valid\u00e9es par votre signature. Avec la souris signez dans le cadre r\u00e9serv\u00e9.","productField":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"signature","id":247,"label":"Signature","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"visible","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","penSize":"","boxWidth":"","borderWidth":"","displayOnly":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"text","id":210,"label":"Praticien qui peuvent prendre en charge","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","enablePasswordInput":"","maxLength":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"displayOnly":"","visibility":"administrative","fields":"","inputMaskIsCustom":""},{"type":"page","id":78,"label":"","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"nextButton":{"type":"text","text":"Suivant","imageUrl":"","conditionalLogic":{"actionType":"hide","logicType":"all","rules":[{"fieldId":"134","operator":"is","value":""},{"fieldId":"4","operator":"is","value":""}]}},"previousButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"formId":8,"description":"","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"134","operator":"is","value":""}]},"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"section","id":225,"label":"Pour finir","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"displayOnly":true,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","description":"","conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"134","operator":"is","value":""}]},"formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","useRichTextEditor":false,"visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"textarea","id":52,"label":"Merci de nous indiquer toute remarque suppl\u00e9mentaire pouvant aider \u00e0 la compr\u00e9hension de votre demande, elle sera transmise au praticien","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"checkbox","id":119,"label":"Conditions G\u00e9n\u00e9rales d'Utilisation","adminLabel":"","isRequired":true,"size":"medium","errorMessage":"","choices":[{"text":"J'ai lu et compris <a href=\"https:\/\/oraalgo.com\/mentions-legales\/\" target=\"_blank\">les conditions g\u00e9n\u00e9rales d'utilisation<\/a> du site et je les accepte","value":"J'ai lu et compris <a href=\"https:\/\/oraalgo.com\/mentions-legales\/\" target=\"_blank\">les conditions g\u00e9n\u00e9rales d'utilisation<\/a> du site et je les accepte","isSelected":false,"price":""}],"inputs":[{"id":"119.1","label":"J'ai lu et compris <a href=\"https:\/\/oraalgo.com\/mentions-legales\/\" target=\"_blank\">les conditions g\u00e9n\u00e9rales d'utilisation<\/a> du site et je les accepte","name":""}],"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"description":"Notre service respecte le r\u00e8glement g\u00e9n\u00e9ral sur la protection des donn\u00e9es (RGPD).","formId":8,"inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","conditionalLogic":"","displayOnly":"","visibility":"visible","useRichTextEditor":false,"fields":"","maxLength":"","inputMaskIsCustom":""},{"id":57,"label":"Prouvez que vous n'\u00eates pas un robot en cochant la case suivante","adminLabel":"","type":"gf_no_captcha_recaptcha","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"inputMask":false,"inputMaskValue":"","allowsPrepopulate":false,"formId":8,"description":"","inputType":"","cssClass":"","inputName":"","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","displayOnly":"","recaptcha_theme":"light","prso_pluploader_file_extensions":"jpg,gif,png","prso_pluploader_file_size":"1","prso_pluploader_max_files":"5","visibility":"visible","fields":"","maxLength":"","inputMaskIsCustom":""},{"type":"textarea","id":303,"label":"Remarques praticien","adminLabel":"","isRequired":false,"size":"medium","errorMessage":"","inputs":null,"formId":8,"description":"les remarques indiqu\u00e9s ici ne sont pas visible par le patient","allowsPrepopulate":false,"inputMask":false,"inputMaskValue":"","inputType":"","labelPlacement":"","descriptionPlacement":"","subLabelPlacement":"","placeholder":"","cssClass":"","inputName":"","visibility":"hidden","noDuplicates":false,"defaultValue":"","choices":"","conditionalLogic":"","productField":"","form_id":"","useRichTextEditor":false,"multipleFiles":false,"maxFiles":"","calculationFormula":"","calculationRounding":"","enableCalculation":"","disableQuantity":false,"displayAllCategories":false,"displayOnly":"","fields":"","maxLength":"","inputMaskIsCustom":""}],"firstPageCssClass":"","id":8,"labelPlacement":"top_label","lastPageButton":{"type":"text","text":"Pr\u00e9c\u00e9dent","imageUrl":""},"pagination":{"type":"percentage","pages":["","","","","","","","","",""],"style":"custom","backgroundColor":"#22adc2","color":"","display_progressbar_on_confirmation":false,"progressbar_completion_text":null},"postContentTemplate":"","postContentTemplateEnabled":false,"postTitleTemplate":"","postTitleTemplateEnabled":false,"title":"T\u00e9l\u00e9consultation gratuite et confidentielle","useCurrentUserAsAuthor":true,"version":"2.4.8","subLabelPlacement":"above","cssClass":"","enableHoneypot":true,"enableAnimation":true,"save":{"enabled":false,"button":{"type":"link","text":"Save and Continue Later"}},"limitEntries":false,"limitEntriesCount":"","limitEntriesPeriod":"","limitEntriesMessage":"","scheduleForm":false,"scheduleStart":"","scheduleStartHour":"","scheduleStartMinute":"","scheduleStartAmpm":"","scheduleEnd":"","scheduleEndHour":"","scheduleEndMinute":"","scheduleEndAmpm":"","schedulePendingMessage":"","scheduleMessage":"","requireLogin":false,"requireLoginMessage":"","gfpdf_form_settings":{"577f60a5515d6":{"name":"Doff Patient Template","template":"doff-patient-template","filename":"Mon Checkup","conditionalLogic":null,"pdf_size":"A4","custom_pdf_size":["","","millimeters"],"orientation":"portrait","font":"dejavusanscondensed","font_size":"10","font_colour":"#000000","rtl":"No","format":"PDFA1B","security":"Yes","password":"","privileges":["copy","print","print-highres","assemble"],"image_dpi":"96","save":"No","public_access":"No","restrict_owner":"No","id":"577f60a5515d6","active":false},"577f60a575af4":{"template":"doff-patient-paid-template","pdf_size":"A4","format":"PDFA1B","filename":"Mon Conseil Personnalis\u00e9","security":"Yes","privileges":["copy","print","assemble","print-highres"],"password":"","master_password":"","id":"577f60a575af4","active":false,"name":"Doff Patient Paid Template","conditionalLogic":""},"577f60a596e80":{"template":"doff-practitioner-template","pdf_size":"A4","format":"PDFA1B","filename":"Votre patient a besoin de votre aide","security":"Yes","notification":["55f82e4da7668"],"privileges":["copy","print","assemble","print-highres"],"password":"","master_password":"","id":"577f60a596e80","active":false,"name":"Doff Practitioner Template","conditionalLogic":""},"577f60a5bfa8a":{"template":"default-template","pdf_size":"A4","format":"Standard","filename":"Patient_filled_form","notification":["559d52f3123f3"],"id":"577f60a5bfa8a","active":false,"name":"Default Template","conditionalLogic":""},"5786457f9ae61":{"template":"doff-patient-template","pdf_size":"A4","format":"PDFA1B","filename":"Mon Checkup","security":"Yes","privileges":["copy","print","assemble","print-highres"],"password":"","master_password":"","id":"5786457f9ae61","active":true,"name":"Doff Patient Template","conditionalLogic":""},"5786457fb7dce":{"template":"doff-patient-paid-template","pdf_size":"A4","format":"PDFA1B","filename":"Mon Conseil Personnalis\u00e9","security":"Yes","privileges":["copy","print","assemble","print-highres"],"password":"","master_password":"","id":"5786457fb7dce","active":true,"name":"Doff Patient Paid Template","conditionalLogic":""},"5786457fdec69":{"name":"Doff Practitioner Template","template":"doff-practitioner-template","notification":["55f82e4da7668"],"filename":"Votre patient a besoin de votre aide","conditionalLogic":null,"pdf_size":"A4","custom_pdf_size":["0","0","millimeters"],"orientation":"portrait","font":"dejavusanscondensed","font_size":"10","font_colour":"#000000","rtl":"No","format":"PDFA1B","security":"Yes","password":"","privileges":["copy","print","print-highres","assemble"],"image_dpi":"96","save":"No","public_access":"No","restrict_owner":"No","id":"5786457fdec69","active":false},"57864580092a0":{"template":"default-template","pdf_size":"A4","format":"Standard","filename":"Patient_filled_form","notification":["559d52f3123f3"],"id":"57864580092a0","active":true,"name":"Default Template","conditionalLogic":""},"5899f6376a630":{"name":"NEW Praticioner PDF","template":"doff-practitioner-template","notification":["55f82e4da7668"],"filename":"{Votre nom complet (Pr\u00e9nom):74.3}_{Votre nom complet (Suffixe):74.6}_{date_created}_{entry_id}","conditionalLogic":null,"pdf_size":"A4","custom_pdf_size":["0","0","millimeters"],"orientation":"portrait","font":"dejavusanscondensed","font_size":"10","font_colour":"#000000","rtl":"No","format":"PDFA1B","security":"No","password":"","privileges":["copy","print","print-highres","modify","annot-forms","fill-forms","extract","assemble"],"image_dpi":"96","save":"No","public_access":"No","restrict_owner":"No","id":"5899f6376a630","active":true}},"is_active":"1","date_created":"2015-09-08 15:40:50","is_trash":"0","gfiframe":{"is_enabled":"1","display_title":"0","display_description":"0"},"nextFieldId":343,"confirmations":[{"id":"559d52f3186d6","isDefault":true,"message":"[checkup-confirmation doff_lead_id={entry_id}]","name":"Confirmation par d\u00e9faut","pageId":0,"queryString":"","type":"message","url":"","disableAutoformat":true,"conditionalLogic":[],"stickylist_confirmation_type":""}],"notifications":[{"isActive":true,"id":"559d52f3123f3","name":"Admin notification","service":"wordpress","event":"doff_after_checkup_submission_and_result_computation","to":"{admin_email}","toType":"email","cc":"","bcc":"","subject":"{entry_id} Checkup {Votre nom complet (Pr\u00e9nom):74.3} {Votre nom complet (Middle):74.4} {Votre nom complet (Suffixe):74.8}","message":"{all_fields}","from":"{admin_email}","fromName":"Oral Checkup","replyTo":"resultats@oraalgo.fr","routing":null,"conditionalLogic":null,"disableAutoformat":false,"enableAttachments":false},{"isActive":true,"id":"55f81bbc5d6f3","name":"Patient notification","service":"wordpress","event":"doff_after_checkup_submission_and_result_computation","to":"","toType":"routing","bcc":"admin_wp@oraalgo.com","subject":"Vos R\u00e9sultats Du Checkup Oral","message":"to be replaced...","from":"{admin_email}","fromName":"Oraalgo","replyTo":"","routing":[{"fieldId":"134","operator":"isnot","value":"","email":"{user:user_email}"},{"fieldId":"134","operator":"is","value":"","email":"{Cr\u00e9er un compte:4}"}],"conditionalLogic":null,"disableAutoformat":false},{"isActive":true,"id":"55f82e4da7668","name":"Practitioner notification","service":"wordpress","event":"doff_after_checkup_submission_and_result_computation","to":"76","toType":"field","bcc":"{admin_email}","subject":"Votre patient {user:firstname} {user:lastname} a besoin de vous","message":"Ch\u00e8r(e) confr\u00e8re(soeur),\r\n<br\/><br\/>\r\nVotre patient {Votre nom complet:74} ({Votre adresse e-mail:4}) a rempli le questionnaire m\u00e9dical initial en ligne et vous l'a adress\u00e9. Pour consulter ses r\u00e9sultats, il vous suffit de:\r\n<ol>\r\n<li>Vous <a href=\"https:\/\/oraalgo.com\/wp-login.php\" target=\"_blank\">connecter au site<\/a> avec vos identifiants (si ce n'est d\u00e9j\u00e0 fait)<\/li>\r\n<li>Puis de cliquer sur le lien suivant : <a target=\"_blank\" href=\"https:\/\/oraalgo.com\/questionnaires-initiaux\/entry\/{entry_id}\/\">Questionnaire {Votre nom complet:74}<\/a><\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<br\/><br\/>\r\nMerci beaucoup\r\n<br\/><br\/>\r\nL'\u00e9quipe sant\u00e9 du site <a href=\"https:\/\/oraalgo.com\/\" target=\"_blank\">Oraalgo<\/a>\r\n<br\/><br\/>\r\nPS : si vous avez oubli\u00e9 votre mot de passe pour vous connecter au site, merci d'<a href=\"https:\/\/oraalgo.com\/my-account\/lost-password\/\" target=\"_blank\">utiliser notre service de r\u00e9cup\u00e9ration de mot de passe.<\/a>","from":"{Votre adresse e-mail:4}","fromName":"Oral Checkup - {Votre nom complet:74}","replyTo":"{Votre adresse e-mail:4}","routing":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"69","operator":"is","value":"Oui"}]},"disableAutoformat":true},{"isActive":false,"id":"56742bb6081ff","name":"Patient paid notification","event":"form_submission","to":"4","toType":"field","bcc":"","subject":"Votre conseil m\u00e9dical personnalis\u00e9","message":"Merci d'avoir achet\u00e9 notre conseil personnalis\u00e9!\r\n\r\nNous esp\u00e9rons qu'il vous permettra de r\u00e9pondre \u00e0 vos questions.\r\n\r\nN'h\u00e9sitez pas \u00e0 nous donner votre retour (cliquer en bas du PDF sur les boutons appropri\u00e9s)\r\n\r\nA bient\u00f4t !\r\n\r\nL'\u00e9quipe sant\u00e9 du site Oraalgo!","from":"{admin_email}","fromName":"","replyTo":"","routing":null,"conditionalLogic":null,"disableAutoformat":false},{"isActive":true,"id":"5928498451779","name":"Practitioner Feedback (sent questionnaire)","service":"wordpress","event":"doff_after_checkup_submission_and_result_computation","to":"76","toType":"field","bcc":"","subject":"{:74.3} {Votre nom complet (Nom):74.6} a rempli son questionnaire","message":"Bonjour,\r\n\r\nNous vous informons que votre patient\u00a0{:74.3} {Votre nom complet (Nom):74.6} a compl\u00e9t\u00e9 le questionnaire en ligne que vous lui aviez envoy\u00e9.\r\n\r\nVous pouvez consulter <a target=\"_blank\" href=\"https:\/\/oraalgo.com\/tableau-de-bord-assistance-clinique\/entry\/{entry_id}\">ses r\u00e9ponses ici<\/a>\r\n\r\nMerci pour votre confiance,\r\n\r\nL'\u00e9quipe Oraalgo","from":"no-reply@oraalgo.com","fromName":"Oraalgo","replyTo":"","routing":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"69","operator":"is","value":"my_practitioner"}]},"disableAutoformat":false},{"isActive":true,"id":"593938ab312a2","name":"Practitioner Feedback (sent questionnaire) - Patient does not share","service":"wordpress","event":"doff_after_checkup_submission_and_result_computation","to":"277","toType":"field","bcc":"","subject":"Votre patient a rempli son questionnaire","message":"Bonjour,\r\n\r\nNous vous informons que votre patient a compl\u00e9t\u00e9 le questionnaire en ligne que vous lui aviez envoy\u00e9 mais n'a pas voulu le partager avec vous.\r\n\r\nMerci pour votre confiance,\r\n\r\nL'\u00e9quipe Oraalgo\r\n\r\n&nbsp;","from":"no-reply@oraalgo.com","fromName":"Oraalgo","replyTo":"","routing":null,"conditionalLogic":{"actionType":"show","logicType":"all","rules":[{"fieldId":"69","operator":"is","value":"solo"},{"fieldId":"277","operator":"isnot","value":""}]},"disableAutoformat":false}]},"version":"2.4.8"}