{"id":190,"date":"2018-02-26T17:08:35","date_gmt":"2018-02-26T16:08:35","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=190"},"modified":"2019-03-26T10:53:02","modified_gmt":"2019-03-26T09:53:02","slug":"inscription-rdv-retino","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/inscription-rdv-retino\/","title":{"rendered":"Inscription au d\u00e9pistage de la r\u00e9tinopathie diab\u00e9tique"},"content":{"rendered":"<p style=\"text-align: justify;\">Vous \u00eates diab\u00e9tique et avez moins de 70 ans, l&rsquo;Assurance Maladie de Loir-et-Cher et le R\u00e9seau Sant\u00e9 Nutrition Diab\u00e8te (RSND41) vous invitent \u00e0 <strong>r\u00e9aliser un fond d&rsquo;\u0153il de d\u00e9pistage de la r\u00e9tinopathie diab\u00e9tique<\/strong> pr\u00e8s de chez vous.<\/p>\n<p style=\"text-align: justify;\">Pour vous inscrire gratuitement, compl\u00e9tez le formulaire ci-dessous.<\/p>\n<hr \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f189-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"189\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/190#wpcf7-f189-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"189\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f189-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p> T\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Fixe\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Fixe\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p>&nbsp;<br \/>\nJe souhaite m'inscrire au rendez-vous de d\u00e9pistage du : <i> (s\u00e9lectionnez une date) <\/i><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"RDVRetino\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Mercredi 3 avril 2019 \u00e0 Onzain\" \/><span class=\"wpcf7-list-item-label\">Mercredi 3 avril 2019 \u00e0 Onzain<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Jeudi 4 avril 2019 \u00e0 Saint-Aignan\" \/><span class=\"wpcf7-list-item-label\">Jeudi 4 avril 2019 \u00e0 Saint-Aignan<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Mardi 14 mai 2019 \u00e0 Contres\" \/><span class=\"wpcf7-list-item-label\">Mardi 14 mai 2019 \u00e0 Contres<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Vendredi 14 juin 2019 \u00e0 Vend\u00f4me\" \/><span class=\"wpcf7-list-item-label\">Vendredi 14 juin 2019 \u00e0 Vend\u00f4me<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Jeudi 12 septembre 2019 \u00e0 Selles-sur-Cher\" \/><span class=\"wpcf7-list-item-label\">Jeudi 12 septembre 2019 \u00e0 Selles-sur-Cher<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Jeudi 3 octobre 2019 \u00e0 Saint-Georges-sur-Cher\" \/><span class=\"wpcf7-list-item-label\">Jeudi 3 octobre 2019 \u00e0 Saint-Georges-sur-Cher<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"RDVRetino\" value=\"Jeudi 21 novembre 2019 \u00e0 Romorantin-Lanthenay\" \/><span class=\"wpcf7-list-item-label\">Jeudi 21 novembre 2019 \u00e0 Romorantin-Lanthenay<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"2969252098\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/2969252098.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"103\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Vous \u00eates diab\u00e9tique et avez moins de 70 ans, l&rsquo;Assurance Maladie de Loir-et-Cher et le R\u00e9seau Sant\u00e9 Nutrition Diab\u00e8te (RSND41) vous invitent \u00e0 r\u00e9aliser un fond d&rsquo;\u0153il de d\u00e9pistage de la r\u00e9tinopathie diab\u00e9tique pr\u00e8s de chez vous. Pour vous inscrire gratuitement, compl\u00e9tez le formulaire ci-dessous.<\/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-190","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/190"}],"collection":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/comments?post=190"}],"version-history":[{"count":10,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/190\/revisions"}],"predecessor-version":[{"id":219,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/190\/revisions\/219"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}