{"id":515,"date":"2023-02-15T14:01:26","date_gmt":"2023-02-15T13:01:26","guid":{"rendered":"https:\/\/redbroker.ch\/?page_id=515"},"modified":"2023-02-15T15:16:27","modified_gmt":"2023-02-15T14:16:27","slug":"formulaire","status":"publish","type":"page","link":"https:\/\/redbroker.ch\/index.php\/formulaire\/","title":{"rendered":"Formulaire"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.19.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.19.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.19.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][wpforms_selector form_id=\u00a0\u00bb518&Prime; show_title=\u00a0\u00bbon\u00a0\u00bb _builder_version=\u00a0\u00bb4.19.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/wpforms_selector][et_pb_text _builder_version=\u00a0\u00bb4.19.5&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_margin=\u00a0\u00bb10px|||||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><span style=\"color: #808080;\"><em>En cliquant sur Envoyer, j\u2019accepte que mes donn\u00e9es soient transmises \u00e0 un partenaire afin que ce dernier me fasse parvenir les offres demand\u00e9es<\/em><\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p><div class=\"et_pb_module wpforms_selector wpforms_selector_0\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module_inner\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-518\"><form id=\"wpforms-form-518\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"518\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/515\" data-token=\"e3d9901c46ecd936a44e3f4dacad110a\" data-token-time=\"1775398877\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Demander votre offre gratuitement<\/div><\/div><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-518-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_2\">Civilit\u00e9 <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-518-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required=\"required\"><option value=\"Mme.\"  class=\"choice-1 depth-1\"  >Mme.<\/option><option value=\"M.\"  class=\"choice-2 depth-1\"  >M.<\/option><\/select><\/div><div id=\"wpforms-518-field_3-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Profil <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-518-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_3_1\" name=\"wpforms[fields][3]\" value=\"Famille\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_3_1\">Famille<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_3_2\" name=\"wpforms[fields][3]\" value=\"En couple\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_3_2\">En couple<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_3_3\" name=\"wpforms[fields][3]\" value=\"Seul(e)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_3_3\">Seul(e)<\/label><\/li><\/ul><\/div><div id=\"wpforms-518-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_4\">Nom et pr\u00e9nom <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-518-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-518-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_8\">Ann\u00e9e de naissance <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-518-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-518-field_9-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_9\">Canton <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-518-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required=\"required\"><option value=\"AG\"  class=\"choice-1 depth-1\"  >AG<\/option><option value=\"AI\"  class=\"choice-2 depth-1\"  >AI<\/option><option value=\"AR\"  class=\"choice-3 depth-1\"  >AR<\/option><option value=\"BE\"  class=\"choice-26 depth-1\"  >BE<\/option><option value=\"BL\"  class=\"choice-25 depth-1\"  >BL<\/option><option value=\"BS\"  class=\"choice-24 depth-1\"  >BS<\/option><option value=\"FR\"  class=\"choice-23 depth-1\"  >FR<\/option><option value=\"GE\"  class=\"choice-22 depth-1\"  >GE<\/option><option value=\"GL\"  class=\"choice-21 depth-1\"  >GL<\/option><option value=\"GR\"  class=\"choice-20 depth-1\"  >GR<\/option><option value=\"JU\"  class=\"choice-19 depth-1\"  >JU<\/option><option value=\"LU\"  class=\"choice-18 depth-1\"  >LU<\/option><option value=\"NE\"  class=\"choice-17 depth-1\"  >NE<\/option><option value=\"NW\"  class=\"choice-16 depth-1\"  >NW<\/option><option value=\"OW\"  class=\"choice-15 depth-1\"  >OW<\/option><option value=\"SG\"  class=\"choice-14 depth-1\"  >SG<\/option><option value=\"SH\"  class=\"choice-13 depth-1\"  >SH<\/option><option value=\"SO\"  class=\"choice-12 depth-1\"  >SO<\/option><option value=\"SZ\"  class=\"choice-11 depth-1\"  >SZ<\/option><option value=\"TG\"  class=\"choice-10 depth-1\"  >TG<\/option><option value=\"TI\"  class=\"choice-9 depth-1\"  >TI<\/option><option value=\"UR\"  class=\"choice-8 depth-1\"  >UR<\/option><option value=\"VD\"  class=\"choice-7 depth-1\"  >VD<\/option><option value=\"VS\"  class=\"choice-6 depth-1\"  >VS<\/option><option value=\"ZG\"  class=\"choice-5 depth-1\"  >ZG<\/option><option value=\"ZH\"  class=\"choice-4 depth-1\"  >ZH<\/option><\/select><\/div><div id=\"wpforms-518-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_11\">Caisse maladie actuelle <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-518-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"Aucune\"  class=\"choice-1 depth-1\"  >Aucune<\/option><option value=\"Aerosana\"  class=\"choice-2 depth-1\"  >Aerosana<\/option><option value=\"Agrisano\"  class=\"choice-3 depth-1\"  >Agrisano<\/option><option value=\"Aquilana\"  class=\"choice-26 depth-1\"  >Aquilana<\/option><option value=\"Arcosana\"  class=\"choice-25 depth-1\"  >Arcosana<\/option><option value=\"Assura\"  class=\"choice-24 depth-1\"  >Assura<\/option><option value=\"Atupri\"  class=\"choice-23 depth-1\"  >Atupri<\/option><option value=\"Avanex\"  class=\"choice-22 depth-1\"  >Avanex<\/option><option value=\"Avantis\"  class=\"choice-21 depth-1\"  >Avantis<\/option><option value=\"Avenir\"  class=\"choice-20 depth-1\"  >Avenir<\/option><option value=\"Concordia\"  class=\"choice-19 depth-1\"  >Concordia<\/option><option value=\"CSS\"  class=\"choice-18 depth-1\"  >CSS<\/option><option value=\"EGK\"  class=\"choice-17 depth-1\"  >EGK<\/option><option value=\"Galenos\"  class=\"choice-16 depth-1\"  >Galenos<\/option><option value=\"Helsana\"  class=\"choice-15 depth-1\"  >Helsana<\/option><option value=\"Innova\"  class=\"choice-14 depth-1\"  >Innova<\/option><option value=\"Intras\"  class=\"choice-13 depth-1\"  >Intras<\/option><option value=\"Kolping\"  class=\"choice-12 depth-1\"  >Kolping<\/option><option value=\"KPT\/CPT\"  class=\"choice-11 depth-1\"  >KPT\/CPT<\/option><option value=\"EASY SANA\"  class=\"choice-10 depth-1\"  >EASY SANA<\/option><option value=\"La Caisse Vaudoise\"  class=\"choice-9 depth-1\"  >La Caisse Vaudoise<\/option><option value=\"Mutuel\"  class=\"choice-8 depth-1\"  >Mutuel<\/option><option value=\"Philos Caisse\"  class=\"choice-7 depth-1\"  >Philos Caisse<\/option><option value=\"Progr\u00e8s\"  class=\"choice-6 depth-1\"  >Progr\u00e8s<\/option><option value=\"Provita\"  class=\"choice-5 depth-1\"  >Provita<\/option><option value=\"Sanitas\"  class=\"choice-4 depth-1\"  >Sanitas<\/option><option value=\"Sansan\"  class=\"choice-30 depth-1\"  >Sansan<\/option><option value=\"SKBH\"  class=\"choice-29 depth-1\"  >SKBH<\/option><option value=\"Sodalis\"  class=\"choice-28 depth-1\"  >Sodalis<\/option><option value=\"Supra\"  class=\"choice-27 depth-1\"  >Supra<\/option><option value=\"Swica\"  class=\"choice-35 depth-1\"  >Swica<\/option><option value=\"Sympany\"  class=\"choice-34 depth-1\"  >Sympany<\/option><option value=\"Universa\"  class=\"choice-33 depth-1\"  >Universa<\/option><option value=\"Visana\"  class=\"choice-32 depth-1\"  >Visana<\/option><option value=\"Wincare\"  class=\"choice-31 depth-1\"  >Wincare<\/option><option value=\"Xundheit\"  class=\"choice-41 depth-1\"  >Xundheit<\/option><option value=\"OKK\"  class=\"choice-40 depth-1\"  >OKK<\/option><option value=\"Autres\"  class=\"choice-39 depth-1\"  >Autres<\/option><\/select><\/div><div id=\"wpforms-518-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_12\">Pr\u00e9f\u00e9rence de contact <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-518-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"Toute la journ\u00e9e\"  class=\"choice-1 depth-1\"  >Toute la journ\u00e9e<\/option><option value=\"Le matin\"  class=\"choice-2 depth-1\"  >Le matin<\/option><option value=\"L&#039;apr\u00e8s-midi\"  class=\"choice-3 depth-1\"  >L'apr\u00e8s-midi<\/option><option value=\"Le soir\"  class=\"choice-26 depth-1\"  >Le soir<\/option><\/select><\/div><div id=\"wpforms-518-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Nb offre souhait\u00e9e <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-518-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_13_1\" name=\"wpforms[fields][13]\" value=\"Une seule offre comparative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_13_1\">Une seule offre comparative<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_13_2\" name=\"wpforms[fields][13]\" value=\"Deux offres comparatives\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_13_2\">Deux offres comparatives<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-518-field_13_3\" name=\"wpforms[fields][13]\" value=\"Trois offres comparatives\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_13_3\">Trois offres comparatives<\/label><\/li><\/ul><\/div><div id=\"wpforms-518-field_14-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_14\">E-mail <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-518-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-518-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_15\">T\u00e9l\u00e9phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-518-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" step=\"any\" required><\/div><div id=\"wpforms-518-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_16\">Adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-518-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" required><\/div><div id=\"wpforms-518-field_17-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_17\">Code postal <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-518-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" step=\"any\" required><\/div><div id=\"wpforms-518-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-518-field_18\">Commune<\/label><input type=\"text\" id=\"wpforms-518-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-518-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Cocher si c&#039;est le cas <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-518-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-518-field_19_1\" name=\"wpforms[fields][19][]\" value=\"Je pratique une activit\u00e9 physique r\u00e9guli\u00e8re\u200e\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-518-field_19_1\">Je pratique une activit\u00e9 physique r\u00e9guli\u00e8re\u200e<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"518\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/pages\/515\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-518\" 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:\/\/redbroker.ch\/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\t\t\t\t<\/div>\n\t\t\t<\/div>En cliquant sur Envoyer, j\u2019accepte que mes donn\u00e9es soient transmises \u00e0 un partenaire afin que ce dernier me fasse parvenir les offres demand\u00e9es<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/pages\/515"}],"collection":[{"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/comments?post=515"}],"version-history":[{"count":6,"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/pages\/515\/revisions"}],"predecessor-version":[{"id":537,"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/pages\/515\/revisions\/537"}],"wp:attachment":[{"href":"https:\/\/redbroker.ch\/index.php\/wp-json\/wp\/v2\/media?parent=515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}