{"id":1728,"date":"2025-10-09T18:44:05","date_gmt":"2025-10-09T18:44:05","guid":{"rendered":"https:\/\/radx.ca\/?page_id=1728"},"modified":"2026-03-18T20:24:48","modified_gmt":"2026-03-18T20:24:48","slug":"envoyer-une-prescription","status":"publish","type":"page","link":"https:\/\/radx.ca\/en\/envoyer-une-prescription\/","title":{"rendered":"Submit your prescription"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1728\" class=\"elementor elementor-1728\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c1654d2 animated-slow e-flex e-con-boxed elementor-invisible e-con e-parent\" data-id=\"c1654d2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-feadbf6 e-flex e-con-boxed elementor-invisible e-con e-parent\" data-id=\"feadbf6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;,&quot;animation_delay&quot;:250}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bf19363 elementor-widget elementor-widget-heading\" data-id=\"bf19363\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Nous vous recontacterons rapidement afin de vous proposer un rendez-vous d\u00e8s que possible !<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-20a426c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"20a426c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-929bd61 e-con-full e-flex e-con e-child\" data-id=\"929bd61\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-660d661 elementor-widget__width-initial upload-form elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"660d661\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;30&quot;,&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Nouveau formulaire\" aria-label=\"Nouveau formulaire\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1728\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"660d661\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Joindre votre prescription en toute s\u00e9curit\u00e9 - RADX\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1728\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_73e302e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_73e302e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChoisisez la Clinique de votre choix\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_73e302e]\" id=\"form-field-field_73e302e\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"cdn@radx.ca\">RadX - C\u00f4te-des-Neiges<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"viau@radx.ca\">RadX -  Viau<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_de933ed elementor-col-100\">\n\t\t\t\t\t<hr>\n<h3 style=\"color:#F3FBFF;padding-top:10px;\">Renseignement Personnel<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6276332 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6276332\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6276332]\" id=\"form-field-field_6276332\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCourriel\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_08ffcc9 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_08ffcc9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate de naissance\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_08ffcc9]\" id=\"form-field-field_08ffcc9\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_7c8deae elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7c8deae\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNo. t\u00e9l\u00e9phone principal\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_7c8deae]\" id=\"form-field-field_7c8deae\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_ec5222a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ec5222a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNo. de c\u00e9llulaire \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_ec5222a]\" id=\"form-field-field_ec5222a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_64f0ffb elementor-col-100\">\n\t\t\t\t\t<hr style=\"margin-bottom:20px;\">\n<h3 style=\"color:#F3FBFF;\">D\u00e9tails de la prescription<\/h3>\n<p style=\"color:white;\">Note: Veuillez avoir l\u2019original de votre prescription avec vous lors de votre rendez-vous. Si vous avez plusieurs prescriptions \u00e0 nous envoyer, merci de les regrouper dans un seul fichier PDF.<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_e6fde15 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_e6fde15]\" id=\"form-field-field_e6fde15\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" data-maxsize=\"3\" data-maxsize-message=\"Ce fichier d\u00e9passe la taille maximale autoris\u00e9e.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInformations suppl\u00e9mentaires\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_e2f26bf elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_e2f26bf]\" id=\"form-field-field_e2f26bf\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_e2f26bf\">Je consens \u00e0 l'utilisation de mes renseignements personnels comme il est pr\u00e9cis\u00e9 dans <a href=\"\/privacy-policy\" style=\"color:#B9D8E4;\">la politique de protection de la vie priv\u00e9e.<\/a><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-30 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-715cbc6 e-flex e-con-boxed e-con e-parent\" data-id=\"715cbc6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Soumettez votre prescription en ligne pour planifier votre examen rapidement. Un service simple, s\u00e9curis\u00e9 et efficace avec notre \u00e9quipe.<\/p>","protected":false},"author":2,"featured_media":2821,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1728","page","type-page","status-publish","has-post-thumbnail","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/pages\/1728","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/comments?post=1728"}],"version-history":[{"count":174,"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/pages\/1728\/revisions"}],"predecessor-version":[{"id":2824,"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/pages\/1728\/revisions\/2824"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/media\/2821"}],"wp:attachment":[{"href":"https:\/\/radx.ca\/en\/wp-json\/wp\/v2\/media?parent=1728"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}