{"id":1536,"date":"2026-01-09T15:07:08","date_gmt":"2026-01-09T15:07:08","guid":{"rendered":"https:\/\/drgilberttremblay.com\/dentiste-referent\/"},"modified":"2026-02-20T21:39:13","modified_gmt":"2026-02-20T21:39:13","slug":"dentiste-referent","status":"publish","type":"page","link":"https:\/\/drgilberttremblay.com\/fr\/dentiste-referent\/","title":{"rendered":"Dentiste Re\u0301fe\u0301rent"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1536\" class=\"elementor elementor-1536 elementor-1442\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c9fff00 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile e-flex e-con-boxed e-con e-parent\" data-id=\"c9fff00\" 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<div class=\"elementor-element elementor-element-f4fbb9d e-con-full e-flex e-con e-child\" data-id=\"f4fbb9d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6807cbf elementor-widget elementor-widget-heading\" data-id=\"6807cbf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Dentiste Re\u0301fe\u0301rent<\/h3>\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-f04f65e e-flex e-con-boxed e-con e-parent\" data-id=\"f04f65e\" 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<div class=\"elementor-element elementor-element-01acb1b e-con-full e-flex e-con e-child\" data-id=\"01acb1b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1952f9d elementor-widget elementor-widget-heading\" data-id=\"1952f9d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Demande de r\u00e9f\u00e9rence en implantologie dentaire<\/h3>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7827b43 e-con-full e-flex e-con e-child\" data-id=\"7827b43\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-11b2282 ReferralDental elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"11b2282\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&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\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Orientation vers une \u00e9valuation et un traitement en implantologie dentaire\" aria-label=\"Orientation vers une \u00e9valuation et un traitement en implantologie dentaire\">\r\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1536\"\/>\r\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"11b2282\"\/>\r\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Dentiste Re\u0301fe\u0301rent\" \/>\r\n\r\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1536\"\/>\r\n\t\t\t\r\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-consult elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-consult\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tDate\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\r\n\t\t<input type=\"date\" name=\"form_fields[consult]\" id=\"form-field-consult\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a8c997b elementor-col-100\">\r\n\t\t\t\t\t<p>\n        \u00c0 l\u2019attention de : Dr Gilbert Tremblay B.Sc., D.M.D. <br>Certifi\u00e9 par l\u2019American Board of Oral Implantolgy\/ID<br>Clinique : 1555 Boul de l\u2019Avenir, Laval <br>T\u00e9l\u00e9phone : 514 609 4675 <\/p>\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ce30285 elementor-col-100 elementor-field-required\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ce30285\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tNom du patient \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ce30285]\" id=\"form-field-field_ce30285\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Nom du patient \" required=\"required\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_e7df670 elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e7df670\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tIndication clinique \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dent(s) manquante(s)\" id=\"form-field-field_e7df670-0\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-0\">Dent(s) manquante(s)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dent(s) non restaurable(s)\" id=\"form-field-field_e7df670-1\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-1\">Dent(s) non restaurable(s)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Espace \u00e9dent\u00e9 n\u00e9cessitant une r\u00e9habilitation proth\u00e9tique\" id=\"form-field-field_e7df670-2\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-2\">Espace \u00e9dent\u00e9 n\u00e9cessitant une r\u00e9habilitation proth\u00e9tique<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dysfonctionnement (mastication\/\u00e9locution)\" id=\"form-field-field_e7df670-3\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-3\">Dysfonctionnement (mastication\/\u00e9locution)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pr\u00e9occupations esth\u00e9tiques\" id=\"form-field-field_e7df670-4\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-4\">Pr\u00e9occupations esth\u00e9tiques<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autre\" id=\"form-field-field_e7df670-5\" name=\"form_fields[field_e7df670][]\"> <label for=\"form-field-field_e7df670-5\">Autre<\/label><\/span><\/div>\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ac023b3 elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ac023b3\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tPr\u00e9cisez\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ac023b3]\" id=\"form-field-field_ac023b3\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_70381dd elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_70381dd\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tServices demand\u00e9es \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"\u00c9valuation implantaire compl\u00e8te\" id=\"form-field-field_70381dd-0\" name=\"form_fields[field_70381dd][]\"> <label for=\"form-field-field_70381dd-0\">\u00c9valuation implantaire compl\u00e8te<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pose d\u2019implant(s) dentaire(s)\" id=\"form-field-field_70381dd-1\" name=\"form_fields[field_70381dd][]\"> <label for=\"form-field-field_70381dd-1\">Pose d\u2019implant(s) dentaire(s)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Greffe osseuse \/ En vue \" id=\"form-field-field_70381dd-2\" name=\"form_fields[field_70381dd][]\"> <label for=\"form-field-field_70381dd-2\">Greffe osseuse \/ En vue <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Proth\u00e8se implanto-port\u00e9e\" id=\"form-field-field_70381dd-3\" name=\"form_fields[field_70381dd][]\"> <label for=\"form-field-field_70381dd-3\">Proth\u00e8se implanto-port\u00e9e<\/label><\/span><\/div>\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_38e5b87 elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_38e5b87\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tNom du praticien r\u00e9f\u00e9rent \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_38e5b87]\" id=\"form-field-field_38e5b87\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Nom du praticien r\u00e9f\u00e9rent \">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0fbe9cf elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0fbe9cf\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tNom du cabinet\/\u00e9tablissement \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0fbe9cf]\" id=\"form-field-field_0fbe9cf\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Nom du cabinet\/\u00e9tablissement \">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_13a23de elementor-col-100 elementor-field-required\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_13a23de\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tSignature \t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_13a23de]\" id=\"form-field-field_13a23de\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Signature\" required=\"required\">\r\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_65a1d3b elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_65a1d3b\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tCoordonn\u00e9es no. de t\u00e9l\u00e9phone  du Patient\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_65a1d3b]\" id=\"form-field-field_65a1d3b\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Coordonn\u00e9es no. de t\u00e9l\u00e9phone  du Patient\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\r\n\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_e5b3e5f elementor-col-100\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e5b3e5f\" class=\"elementor-field-label\">\r\n\t\t\t\t\t\t\t\tJoindre le fichier radiographique\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_e5b3e5f]\" id=\"form-field-field_e5b3e5f\" class=\"elementor-field elementor-size-md  elementor-upload-field\">\r\n\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\r\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\r\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\r\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\">Send<\/span>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t<\/button>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/form>\r\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\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Demande de r\u00e9f\u00e9rence en implantologie dentaire<\/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-1536","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/pages\/1536","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/comments?post=1536"}],"version-history":[{"count":35,"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/pages\/1536\/revisions"}],"predecessor-version":[{"id":1913,"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/pages\/1536\/revisions\/1913"}],"wp:attachment":[{"href":"https:\/\/drgilberttremblay.com\/fr\/wp-json\/wp\/v2\/media?parent=1536"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}