{"id":5734,"date":"2024-08-22T09:05:38","date_gmt":"2024-08-22T07:05:38","guid":{"rendered":"https:\/\/www.kreisklinik-gg.de\/?page_id=5734"},"modified":"2024-09-11T09:08:55","modified_gmt":"2024-09-11T07:08:55","slug":"lob-beschwerde-formular","status":"publish","type":"page","link":"https:\/\/www.kreisklinik-gg.de\/fr\/patienten-besucher\/lob-beschwerde-formular\/","title":{"rendered":"\u00c9loge &amp; amp; Plaintes - Formulaire"},"content":{"rendered":"<div class=\"wpb-content-wrapper\" id=\"wpb-content-root\"><div data-vc-full-width=\"true\" data-vc-full-width-temp=\"true\" data-vc-full-width-init=\"false\" data-vc-stretch-content=\"true\" class=\"vc_row wpb_row vc_row-fluid vc_row-no-padding vc_row-o-equal-height vc_row-flex\"><div class=\"wpb_column vc_column_container vc_col-sm-6 vc_hidden-sm vc_hidden-xs\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><\/div><\/div><\/div><div class=\"wpb_column vc_column_container vc_col-sm-6 vc_hidden-sm vc_hidden-xs\"><div class=\"vc_column-inner vc_custom_1650535550235\"><div class=\"wpb_wrapper\"><div id=\"ultimate-heading-33916ae042233c4f0\" class=\"uvc-heading ult-adjust-bottom-margin ultimate-heading-33916ae042233c4f0 uvc-6609  uvc-heading-default-font-sizes\" data-hspacer=\"no_spacer\"  data-halign=\"left\" style=\"text-align:left\"><div class=\"uvc-heading-spacer no_spacer\" style=\"top\"><\/div><div class=\"uvc-main-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-33916ae042233c4f0 h1'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}' ><h1 style=\"--font-weight:theme;color:#ffffff;margin-top:120px;margin-bottom:0px;\">\u00c9loge &amp; Plaintes - Formulaire<\/h1><\/div><\/div><\/div><\/div><\/div><div class=\"wpb_column vc_column_container vc_col-sm-12 vc_hidden-lg vc_hidden-md vc_hidden-xl\"><div class=\"vc_column-inner vc_custom_1650535577017\"><div class=\"wpb_wrapper\"><div id=\"ultimate-heading-3626ae042233c6b8\" class=\"uvc-heading ult-adjust-bottom-margin ultimate-heading-3626ae042233c6b8 uvc-3371  uvc-heading-default-font-sizes\" data-hspacer=\"no_spacer\"  data-halign=\"center\" style=\"text-align:center\"><div class=\"uvc-heading-spacer no_spacer\" style=\"top\"><\/div><div class=\"uvc-sub-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-3626ae042233c6b8 .uvc-sub-heading '  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;\"><\/p>\n<h2><span style=\"color: #ffffff;\">patients-<br \/>\nFiche de commentaires<\/span><\/h2>\n<p><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row-full-width vc_clearfix\"><\/div><!-- Row Backgrounds --><div class=\"upb_bg_img\" data-ultimate-bg=\"url(https:\/\/www.kreisklinik-gg.de\/wp-content\/uploads\/2022\/04\/patienten-aerzte-banner.png)\" data-image-id=\"id^3418|url^https:\/\/www.kreisklinik-gg.de\/wp-content\/uploads\/2022\/04\/patienten-aerzte-banner.png|caption^null|alt^null|title^patienten-aerzte-banner|description^null\" data-ultimate-bg-style=\"vcpb-default\" data-bg-img-repeat=\"no-repeat\" data-bg-img-size=\"cover\" data-bg-img-position=\"\" data-parallx_sense=\"30\" data-bg-override=\"ex-full\" data-bg_img_attach=\"scroll\" data-upb-overlay-color=\"\" data-upb-bg-animation=\"\" data-fadeout=\"\" data-bg-animation=\"left-animation\" data-bg-animation-type=\"h\" data-animation-repeat=\"repeat\" data-fadeout-percentage=\"30\" data-parallax-content=\"\" data-parallax-content-sense=\"30\" data-row-effect-mobile-disable=\"true\" data-img-parallax-mobile-disable=\"true\" data-rtl=\"false\"  data-custom-vc-row=\"\"  data-vc=\"9.0.1\"  data-is_old_vc=\"\"  data-theme-support=\"\"   data-overlay=\"false\" data-overlay-color=\"\" data-overlay-pattern=\"\" data-overlay-pattern-opacity=\"\" data-overlay-pattern-size=\"\"    ><\/div><div class=\"vc_row wpb_row vc_row-fluid vc_custom_1639655758535\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div id=\"ultimate-heading-23736ae042233ceef\" class=\"uvc-heading ult-adjust-bottom-margin ultimate-heading-23736ae042233ceef uvc-1771  uvc-heading-default-font-sizes\" data-hspacer=\"no_spacer\"  data-halign=\"left\" style=\"text-align:left\"><div class=\"uvc-heading-spacer no_spacer\" style=\"top\"><\/div><div class=\"uvc-main-heading ult-responsive\"  data-ultimate-target='.uvc-heading.ultimate-heading-23736ae042233ceef h2'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}' ><h2 style=\"--font-weight:theme;margin-bottom:20px;\">Fiche de feedback<\/h2><\/div><\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f5766-o1\" lang=\"de-DE\" dir=\"ltr\" data-wpcf7-id=\"5766\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/5734#wpcf7-f5766-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\" data-etm-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/5734#wpcf7-f5766-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"5766\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.2.3\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f5766-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.7\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185963118\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6017563\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>Ch\u00e8re patiente, cher patient\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<p>Votre avis est important pour nous. C'est pourquoi nous vous demandons de nous donner un bref retour d'information sur votre hospitalisation afin que nous puissions mieux nous adapter \u00e0 vos souhaits et \u00e0 vos besoins.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<p>Les donn\u00e9es du questionnaire ne sont collect\u00e9es qu'\u00e0 des fins statistiques dans le cadre de l'assurance de la qualit\u00e9. Nous garantissons que les donn\u00e9es personnelles ne seront pas transmises \u00e0 des tiers ou qu'elles ne pourront pas \u00eatre consult\u00e9es par des tiers.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6731484\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-5981507\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>Informations personnelles\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-5727087\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-8858725\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Nom\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"Name\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-1645185739517\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Votre adresse e-mail*\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email-adress\"><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\" placeholder=\"@\" value=\"\" type=\"email\" name=\"email-adress\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1511678423660\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185539626\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>\u00c2ge*\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Alter\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"Alter\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185562040\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Sexe*\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Geschlecht\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Geschlecht\" value=\"m\" \/><span class=\"wpcf7-list-item-label\">m<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Geschlecht\" value=\"w\" \/><span class=\"wpcf7-list-item-label\">w<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Geschlecht\" value=\"d\" \/><span class=\"wpcf7-list-item-label\">d<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185512055\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-261507\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>hospitalisation\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-5022536\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-8074660\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Date de\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"datum-von\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datum-von\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-1645185641867\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Date d'expiration\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"datum-bis\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datum-bis\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-4535309\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-685689\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Dans quelle station \u00eates-vous situ\u00e9 ?*\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"abteilung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"abteilung\" value=\"Innere\" \/><span class=\"wpcf7-list-item-label\">Int\u00e9rieur<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"abteilung\" value=\"Chirurgie\" \/><span class=\"wpcf7-list-item-label\">Chirurgie<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-8521275\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Quelle station \u00e9tait responsable de vous?*\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"station\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"station\" value=\"2A\/B\" \/><span class=\"wpcf7-list-item-label\">2A\/B<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"station\" value=\"3A\/B\" \/><span class=\"wpcf7-list-item-label\">3A\/B<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"station\" value=\"Intensiv\" \/><span class=\"wpcf7-list-item-label\">Intense<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"station\" value=\"4A\" \/><span class=\"wpcf7-list-item-label\">4A<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185776513\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645185813008\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Avez-vous \u00e9t\u00e9 aimablement accueilli \u00e0 l'information?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check1\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check1\" value=\"ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check1\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-8808094\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>La r\u00e9ception \u00e0 l'accueil des patients \u00e9tait amicale?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check2\" value=\"ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check2\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-8398371\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Avez-vous \u00e9t\u00e9 inform\u00e9(e) de la possibilit\u00e9 de voter?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check3\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check3\" value=\"ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check3\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-2415589\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>L'h\u00f4pital a-t-il fait une impression nette?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check4\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check4\" value=\"ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check4\" value=\"nein\" \/><span class=\"wpcf7-list-item-label\">non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-9363533\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6253927\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>\u00c9valuez s'il vous pla\u00eet:\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6450327\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-3880190\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Soins m\u00e9dicaux\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check5\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check5\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check5\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check5\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check5\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-92464\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Soins infirmiers\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check6\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check6\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check6\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check6\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check6\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-7564763\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>ambulance\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check7\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check7\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check7\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check7\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check7\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6651047\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>ECG\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check8\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check8\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check8\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check8\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check8\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-9110136\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>endoscopie\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check9\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check9\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check9\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check9\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check9\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-5348936\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>physioth\u00e9rapie\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check10\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check10\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check10\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check10\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check10\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-465004\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>D\u00e9partement des rayons X\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check11\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check11\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check11\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check11\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check11\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-8794560\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Service cible\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check12\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check12\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check12\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check12\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check12\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-4415518\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Op\u00e9ration centrale\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check13\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check13\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check13\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check13\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check13\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6126812\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Cercle des aides\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check14\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check14\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check14\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check14\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check14\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645187319309\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1645187322717\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>Vous nous soutenez ainsi dans nos efforts pour vous offrir, ainsi qu'\u00e0 tous les autres patients, les meilleurs soins possibles.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-2577771\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Qu'est-ce qui vous a particuli\u00e8rement plu ou pas du tout?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check15\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"check15\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-3734027\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Quelles am\u00e9liorations pouvez-vous nous faire?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check16\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"check16\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-265969\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>\u00c9valuez notre nourriture, s'il vous pla\u00eet:\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-882373\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>go\u00fbt\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check17\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check17\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check17\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check17\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check17\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-550085\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Taille des portions\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check18\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check18\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check18\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check18\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check18\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-4918775\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>vari\u00e9t\u00e9\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check19\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check19\" value=\"vorbildlich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">exemplaire<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check19\" value=\"gut\" \/><span class=\"wpcf7-list-item-label\">bien<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check19\" value=\"verbesserungsf\u00e4hig\" \/><span class=\"wpcf7-list-item-label\">Am\u00e9liorable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check19\" value=\"ungen\u00fcgend\" \/><span class=\"wpcf7-list-item-label\">insuffisant<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7-builder-container-row1 cf7-builder-container-row-inner cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-813069\">\n\t<div class=\"cf7-ctrl\">\n\t\t<div class=\"cf7-move\">\n\t\t<\/div>\n\t\t<div class=\"cf7-colunm\">\n\t\t<\/div>\n\t\t<div class=\"cf7-dub cf7-dub-row\">\n\t\t<\/div>\n\t\t<div class=\"cf7-remove\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<div class=\"cf7-builder-container-row-inner-drop ui-droppable ui-sortable\">\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-1416167\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Comment avez-vous pris conscience de nous ou de la clinique de district?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check20\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"check20\" value=\"bereits Patient gewesen\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">d\u00e9j\u00e0 \u00e9t\u00e9 patient<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check20\" value=\"anderes Krankenhaus\" \/><span class=\"wpcf7-list-item-label\">autre h\u00f4pital<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check20\" value=\"durch Empfehlung des Haus- bzw. Facharztes\" \/><span class=\"wpcf7-list-item-label\">par recommandation du m\u00e9decin de famille ou sp\u00e9cialiste<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"check20\" value=\"durch Empfehlung von Freunden\/Bekannten\/Nachbarn\" \/><span class=\"wpcf7-list-item-label\">par la recommandation d'amis\/connaissances\/voisins<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"check20\" value=\"durch Internet\/Prospekt\/Presse\/TV\" \/><span class=\"wpcf7-list-item-label\">par Internet\/Prospectus\/Presse\/TV<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6619944\" >\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"check25\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"autre\" value=\"\" type=\"text\" name=\"check25\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-3550193\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_label\">\n\t\t\t\t\t\t<p>Recommanderiez-vous notre clinique de district?\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"weiterempfehlung\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"weiterempfehlung\" value=\"Ja\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"weiterempfehlung\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-helper ui-sortable-handle\" id=\"cf7-container-builder-8508650\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p>Merci d'avoir r\u00e9pondu, veuillez t\u00e9l\u00e9charger Google reCAPTCHA avant d'envoyer le formulaire\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ui-sortable-placeholder cf7-text cf7-main-builder dropped ui-sortable-handle\" >\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"cf7-text cf7-main-builder dropped ui-sortable-handle\" id=\"cf7-container-builder-6329488\">\n\t\t\t\t\t<div class=\"cf7-ctrl cf7-ctrl-inner\">\n\t\t\t\t\t\t<div class=\"cf7-move\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-edit\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-dub cf7-dub-text\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"cf7-remove\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_font\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"cf7_text_shortcode\">\n\t\t\t\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"FICHE D\u2019INFORMATION\" \/>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div><input type=\"text\" class=\"wpcf7_hp_field\" name=\"wpcf7_hp_field\" value=\"\" tabindex=\"-1\" autocomplete=\"off\" \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"etm-form-language\" value=\"fr\"\/><\/form>\n<\/div>\n\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p>[borlabs-cookie id=\"recaptcha\" type=\"content-blocker\"]Google reCAPTCHA a \u00e9t\u00e9 charg\u00e9.[\/borlabs-cookie]<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><!-- Row Backgrounds --><div class=\"upb_color\" data-bg-override=\"full\" data-bg-color=\"#f1f1f1\" data-fadeout=\"\" data-fadeout-percentage=\"30\" data-parallax-content=\"\" data-parallax-content-sense=\"30\" data-row-effect-mobile-disable=\"true\" data-img-parallax-mobile-disable=\"true\" data-rtl=\"false\"  data-custom-vc-row=\"\"  data-vc=\"9.0.1\"  data-is_old_vc=\"\"  data-theme-support=\"\"   data-overlay=\"false\" data-overlay-color=\"\" data-overlay-pattern=\"\" data-overlay-pattern-opacity=\"\" data-overlay-pattern-size=\"\"    ><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Lob &amp; Plaintes \u2013 Formulaire Fiche de feedback du patient Ch\u00e8re patiente, cher patient Votre avis est important pour nous. C'est pourquoi nous vous demandons de nous donner un bref retour d'information sur votre hospitalisation afin que nous puissions mieux nous adapter \u00e0 vos souhaits et \u00e0 vos besoins. Les donn\u00e9es du questionnaire ne sont utilis\u00e9es qu'\u00e0 des fins statistiques dans le cadre...<\/p>","protected":false},"author":5,"featured_media":0,"parent":1331,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-5734","page","type-page","status-publish","hentry","description-off"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/pages\/5734","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/comments?post=5734"}],"version-history":[{"count":5,"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/pages\/5734\/revisions"}],"predecessor-version":[{"id":5767,"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/pages\/5734\/revisions\/5767"}],"up":[{"embeddable":true,"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/pages\/1331"}],"wp:attachment":[{"href":"https:\/\/www.kreisklinik-gg.de\/fr\/wp-json\/wp\/v2\/media?parent=5734"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}