{"id":147,"date":"2023-07-07T15:12:15","date_gmt":"2023-07-07T13:12:15","guid":{"rendered":"http:\/\/gbe56.fr\/?page_id=147"},"modified":"2024-07-12T18:47:44","modified_gmt":"2024-07-12T16:47:44","slug":"questionnaire-qs-sport","status":"publish","type":"page","link":"https:\/\/gbe56.fr\/index.php\/questionnaire-qs-sport\/","title":{"rendered":"Questionnaire QS-SPORT"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-27140259-9229-4e28-aa7e-63597224f545 wpforms-render-modern\" id=\"wpforms-135\"><form id=\"wpforms-form-135\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"135\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/147\" data-token=\"3830b147fd5d9276afe44809b5af8578\" data-token-time=\"1777520212\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-135-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Pr\u00e9nom Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-135-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-135-field_1-error\" required><label for=\"wpforms-135-field_1\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-135-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-135-field_1-last-error\" required><label for=\"wpforms-135-field_1-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-135-field_2-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">1. Un membre de vore famille est-il d\u00e9c\u00e9d\u00e9 subitement d&#039;une cause cardiaque ou inexpliqu\u00e9e ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-135-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_2_1\" name=\"wpforms[fields][2][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_2_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_2_2\" name=\"wpforms[fields][2][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_2_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_4-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">2. Avez-vous ressenti une douleur dans la poitrine, des palpitations, un essoufflement inhabituel ou un malaise ?<\/legend><ul id=\"wpforms-135-field_4\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_4_1\" name=\"wpforms[fields][4][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_4_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_4_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_4_2\" name=\"wpforms[fields][4][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_4_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_4_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_5-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">3. Avez-vous eu un \u00e9pisode de respiration sifflante (asthme) ?<\/legend><ul id=\"wpforms-135-field_5\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_5_1\" name=\"wpforms[fields][5][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_5_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_5_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_5_2\" name=\"wpforms[fields][5][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_5_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_5_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">4. Avez-vous eu une perte de connaissance ?<\/legend><ul id=\"wpforms-135-field_6\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_6_1\" name=\"wpforms[fields][6][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_6_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_6_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_6_2\" name=\"wpforms[fields][6][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_6_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_6_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_7-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">5. Si vous avez arr\u00eat\u00e9 le sport pendant 30 jours ou plus pour des raisons de sant\u00e9, avez-vous repris sans l&#039;accord d&#039;un m\u00e9decin ?es \u00e0 cocher<\/legend><ul id=\"wpforms-135-field_7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_7_1\" name=\"wpforms[fields][7][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_7_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_7_2\" name=\"wpforms[fields][7][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_7_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_7_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">6. Avez-vous d\u00e9but\u00e9 un traitement m\u00e9dical de longue dur\u00e9e (hors contraception et d\u00e9sensibilisation aux allergies) ?<\/legend><ul id=\"wpforms-135-field_8\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_8_1\" name=\"wpforms[fields][8][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_8_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_8_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_8_2\" name=\"wpforms[fields][8][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_8_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_8_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">7. Ressentez-vous une douleur, un manque de force ou une raideur suite \u00e0 un probl\u00e8me osseux, articulaire ou musculaire (fracture, entorse, luxation, d\u00e9chirure, tendinite, etc&#8230;) survenu durant les 12 derniers mois?<\/legend><ul id=\"wpforms-135-field_9\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_9_1\" name=\"wpforms[fields][9][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_9_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_9_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">8. Votre pratique sportive est-elle interrompue pour des raisons de sant\u00e9 ?<\/legend><ul id=\"wpforms-135-field_10\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_10_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_10_2\" name=\"wpforms[fields][10][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_10_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-135-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">9. Pensez-vous avoir besoin d&#039;un avis m\u00e9dical pour poursuivre votre pratique sportive ?<\/legend><ul id=\"wpforms-135-field_11\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_11_1\" name=\"wpforms[fields][11][]\" value=\"Oui\" aria-errormessage=\"wpforms-135-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_11_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-135-field_11_2\" name=\"wpforms[fields][11][]\" value=\"Non\" aria-errormessage=\"wpforms-135-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-135-field_11_2\">Non<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-hcaptcha\" ><div class=\"g-recaptcha\" data-sitekey=\"93127432-1745-430d-bdc5-0a4736f7c1e1\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-hcaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"135\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/pages\/147\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-135\" class=\"wpforms-submit\" data-alt-text=\"Envoi...\" data-submit-text=\"Envoyer\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/gbe56.fr\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n<p><strong><em>Si vous avez r\u00e9pondu OUI \u00e0 une ou plusieurs questions, un certificat m\u00e9dical sera \u00e0 fournir.<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Si vous avez r\u00e9pondu OUI \u00e0 une ou plusieurs questions, un certificat m\u00e9dical sera \u00e0 fournir.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-147","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/pages\/147","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/comments?post=147"}],"version-history":[{"count":3,"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/pages\/147\/revisions"}],"predecessor-version":[{"id":382,"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/pages\/147\/revisions\/382"}],"wp:attachment":[{"href":"https:\/\/gbe56.fr\/index.php\/wp-json\/wp\/v2\/media?parent=147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}