{"id":4153,"date":"2025-05-31T22:25:09","date_gmt":"2025-05-31T20:25:09","guid":{"rendered":"https:\/\/369agara.com\/?page_id=4153"},"modified":"2025-05-31T22:34:01","modified_gmt":"2025-05-31T20:34:01","slug":"formulaire-de-demande-de-rendez-vous","status":"publish","type":"page","link":"https:\/\/369agara.com\/en\/formulaire-de-demande-de-rendez-vous\/","title":{"rendered":"Appointment request form"},"content":{"rendered":"\n\t<section class=\"section hide-for-small\" id=\"section_1067981132\">\n\t\t<div class=\"bg section-bg fill bg-fill bg-loaded bg-loaded\" >\n\n\t\t\t\n\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\n\n<h1 style=\"text-align: center;\"><span style=\"font-family: stay-wild; font-size: 250%; color: #333399;\">Formulaire de demande de rendez-vous<br \/>pour un soin \u00e9nerg\u00e9tique <br \/>pour votre animal<\/span><\/h1>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3513\"><form id=\"wpforms-form-3513\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3513\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/4153\" data-token=\"99a8bc2e4c6c797a071d32811f2dcd24\" data-token-time=\"1778069958\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3513-field_14-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"14\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3513-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_0\">Pr\u00e9nom et Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3513-field_0\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][0]\" aria-errormessage=\"wpforms-3513-field_0-error\" required><\/div><div id=\"wpforms-3513-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3513-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"xxxxxxxxxxxxx@xxxxxx.xxx\" spellcheck=\"false\" aria-errormessage=\"wpforms-3513-field_1-error\" required><\/div><div id=\"wpforms-3513-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_7\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3513-field_7\" class=\"wpforms-field-medium wpforms-field-required\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][7]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-3513-field_7-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3513-field_12-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_12\">Nom de l&#039;animal <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3513-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-3513-field_12-error\" required><\/div><div id=\"wpforms-3513-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Type d&#039;animal <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3513-field_13\" class=\"wpforms-field-required wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-large\" data-choice-limit=\"1\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3513-field_13_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M320 192h17.1c22.1 38.3 63.5 64 110.9 64c11 0 21.8-1.4 32-4v4 32V480c0 17.7-14.3 32-32 32s-32-14.3-32-32V339.2L280 448h56c17.7 0 32 14.3 32 32s-14.3 32-32 32H192c-53 0-96-43-96-96V192.5c0-16.1-12-29.8-28-31.8l-7.9-1c-17.5-2.2-30-18.2-27.8-35.7s18.2-30 35.7-27.8l7.9 1c48 6 84.1 46.8 84.1 95.3v85.3c34.4-51.7 93.2-85.8 160-85.8zm160 26.5v0c-10 3.5-20.8 5.5-32 5.5c-28.4 0-54-12.4-71.6-32h0c-3.7-4.1-7-8.5-9.9-13.2C357.3 164 352 146.6 352 128v0V32 12 10.7C352 4.8 356.7 .1 362.6 0h.2c3.3 0 6.4 1.6 8.4 4.2l0 .1L384 21.3l27.2 36.3L416 64h64l4.8-6.4L512 21.3 524.8 4.3l0-.1c2-2.6 5.1-4.2 8.4-4.2h.2C539.3 .1 544 4.8 544 10.7V12 32v96c0 17.3-4.6 33.6-12.6 47.6c-11.3 19.8-29.6 35.2-51.4 42.9zM432 128a16 16 0 1 0 -32 0 16 16 0 1 0 32 0zm48 16a16 16 0 1 0 0-32 16 16 0 1 0 0 32z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3513-field_13_2\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Chat\" aria-errormessage=\"wpforms-3513-field_13_2-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Chat<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3513-field_13_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M309.6 158.5L332.7 19.8C334.6 8.4 344.5 0 356.1 0c7.5 0 14.5 3.5 19 9.5L392 32h52.1c12.7 0 24.9 5.1 33.9 14.1L496 64h56c13.3 0 24 10.7 24 24v24c0 44.2-35.8 80-80 80H464 448 426.7l-5.1 30.5-112-64zM416 256.1L416 480c0 17.7-14.3 32-32 32H352c-17.7 0-32-14.3-32-32V364.8c-24 12.3-51.2 19.2-80 19.2s-56-6.9-80-19.2V480c0 17.7-14.3 32-32 32H96c-17.7 0-32-14.3-32-32V249.8c-28.8-10.9-51.4-35.3-59.2-66.5L1 167.8c-4.3-17.1 6.1-34.5 23.3-38.8s34.5 6.1 38.8 23.3l3.9 15.5C70.5 182 83.3 192 98 192h30 16H303.8L416 256.1zM464 80a16 16 0 1 0 -32 0 16 16 0 1 0 32 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3513-field_13_1\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Chien\" aria-errormessage=\"wpforms-3513-field_13_1-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Chien<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3513-field_13_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M448 238.1V160h16l9.8 19.6c12.5 25.1 42.2 36.4 68.3 26c20.5-8.2 33.9-28 33.9-50.1V80c0-19.1-8.4-36.3-21.7-48H560c8.8 0 16-7.2 16-16s-7.2-16-16-16H480 448C377.3 0 320 57.3 320 128H224 203.2 148.8c-30.7 0-57.6 16.3-72.5 40.8C33.2 174.5 0 211.4 0 256v56c0 13.3 10.7 24 24 24s24-10.7 24-24V256c0-13.4 6.6-25.2 16.7-32.5c1.6 13 6.3 25.4 13.6 36.4l28.2 42.4c8.3 12.4 6.4 28.7-1.2 41.6c-16.5 28-20.6 62.2-10 93.9l17.5 52.4c4.4 13.1 16.6 21.9 30.4 21.9h33.7c21.8 0 37.3-21.4 30.4-42.1l-20.8-62.5c-2.1-6.4-.5-13.4 4.3-18.2l12.7-12.7c13.2-13.2 20.6-31.1 20.6-49.7c0-2.3-.1-4.6-.3-6.9l84 24c4.1 1.2 8.2 2.1 12.3 2.8V480c0 17.7 14.3 32 32 32h32c17.7 0 32-14.3 32-32V315.7c19.2-19.2 31.5-45.7 32-75.7h0v-1.9zM496 64a16 16 0 1 1 0 32 16 16 0 1 1 0-32z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3513-field_13_3\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Cheval\" aria-errormessage=\"wpforms-3513-field_13_3-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Cheval<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-9 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3513-field_13_9\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 384 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M221.5 51.7C216.6 39.8 204.9 32 192 32s-24.6 7.8-29.5 19.7l-120 288-40 96c-6.8 16.3 .9 35 17.2 41.8s35-.9 41.8-17.2L93.3 384H290.7l31.8 76.3c6.8 16.3 25.5 24 41.8 17.2s24-25.5 17.2-41.8l-40-96-120-288zM264 320H120l72-172.8L264 320z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3513-field_13_9\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Autre\" aria-errormessage=\"wpforms-3513-field_13_9-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Autre<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-3513-field_6-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Localisation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3513-field_6\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][6][address1]\" placeholder=\"Adresse\" aria-errormessage=\"wpforms-3513-field_6-error\" required><label for=\"wpforms-3513-field_6\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3513-field_6-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][6][city]\" placeholder=\"Ville\" aria-errormessage=\"wpforms-3513-field_6-city-error\" required><label for=\"wpforms-3513-field_6-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3513-field_6-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][6][state]\" placeholder=\"D\u00e9partement\" aria-errormessage=\"wpforms-3513-field_6-state-error\" required><label for=\"wpforms-3513-field_6-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3513-field_6-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][6][postal]\" placeholder=\"Code postal\" aria-errormessage=\"wpforms-3513-field_6-postal-error\" required><label for=\"wpforms-3513-field_6-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3513-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_2\">Message <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3513-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" placeholder=\"Quelle est la raison de votre demande ?\" aria-errormessage=\"wpforms-3513-field_2-error\" required><\/textarea><\/div><div id=\"wpforms-3513-field_3-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Heure de rendez-vous souhait\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3513-field_3\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][3][date]\" aria-errormessage=\"wpforms-3513-field_3-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-3513-field_3\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-3513-field_3-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"H:i\" data-step=\"30\" data-rule-time24h=\"true\" data-min-time=\"16:00\" data-max-time=\"21:00\" data-rule-time-limit=\"true\" name=\"wpforms[fields][3][time]\" aria-errormessage=\"wpforms-3513-field_3-time-error\" required><label for=\"wpforms-3513-field_3-time\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3513-field_15-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"15\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3513-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_10\">Comment avez-vous entendu parl\u00e9 de nos services ?<\/label><select id=\"wpforms-3513-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>---<\/option><option value=\"Internet\" >Internet<\/option><option value=\"Facebook\" >Facebook<\/option><option value=\"Linkedin\" >Linkedin<\/option><option value=\"Famille, amis, voisins...\" >Famille, amis, voisins...<\/option><option value=\"Autre\" >Autre<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3513-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3513-field_9\">Avez-vous un code de r\u00e9duction ?<\/label><input type=\"text\" id=\"wpforms-3513-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-3513-field_9-error\" ><\/div><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3513\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/369agara.com\/en\/wp-json\/wp\/v2\/pages\/4153\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3513\" class=\"wpforms-submit\" data-alt-text=\"Envoi en cours\" data-submit-text=\"Envoyer\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/369agara.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\t\t<\/div>\n\n\t\t\n<style>\n#section_1067981132 {\n  padding-top: 30px;\n  padding-bottom: 30px;\n}\n#section_1067981132 .ux-shape-divider--top svg {\n  height: 150px;\n  --divider-top-width: 100%;\n}\n#section_1067981132 .ux-shape-divider--bottom svg {\n  height: 150px;\n  --divider-width: 100%;\n}\n<\/style>\n\t<\/section>\n\t\n\t<section class=\"section show-for-small\" id=\"section_1705967070\">\n\t\t<div class=\"bg section-bg fill bg-fill bg-loaded bg-loaded\" >\n\n\t\t\t\n\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\n\n<h1 style=\"text-align: center;\"><span style=\"font-family: stay-wild; font-size: 200%; color: #333399;\">Formulaire de <br \/>demande de<br \/>rendez-vous<br \/>pour un soin<br \/>\u00e9nerg\u00e9tique<br \/>pour votre animal<\/span><\/h1>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3531\"><form id=\"wpforms-form-3531\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3531\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/4153\" data-token=\"035c7236b809a315c75e11de72dfab79\" data-token-time=\"1778069958\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3531-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_0\">Pr\u00e9nom et nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3531-field_0\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][0]\" aria-errormessage=\"wpforms-3531-field_0-error\" required><\/div><div id=\"wpforms-3531-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3531-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"xxxxxxxxxxxxx@xxxxxx.xxx\" spellcheck=\"false\" aria-errormessage=\"wpforms-3531-field_1-error\" required><\/div><div id=\"wpforms-3531-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_7\">Num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3531-field_7\" class=\"wpforms-field-medium wpforms-field-required\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][7]\" aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\" aria-errormessage=\"wpforms-3531-field_7-error\" required><\/div><div id=\"wpforms-3531-field_12-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_12\">Nom de l&#039;animal <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3531-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-3531-field_12-error\" required><\/div><div id=\"wpforms-3531-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Type d&#039;animal <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3531-field_13\" class=\"wpforms-field-required wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-large\" data-choice-limit=\"1\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3531-field_13_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M320 192h17.1c22.1 38.3 63.5 64 110.9 64c11 0 21.8-1.4 32-4v4 32V480c0 17.7-14.3 32-32 32s-32-14.3-32-32V339.2L280 448h56c17.7 0 32 14.3 32 32s-14.3 32-32 32H192c-53 0-96-43-96-96V192.5c0-16.1-12-29.8-28-31.8l-7.9-1c-17.5-2.2-30-18.2-27.8-35.7s18.2-30 35.7-27.8l7.9 1c48 6 84.1 46.8 84.1 95.3v85.3c34.4-51.7 93.2-85.8 160-85.8zm160 26.5v0c-10 3.5-20.8 5.5-32 5.5c-28.4 0-54-12.4-71.6-32h0c-3.7-4.1-7-8.5-9.9-13.2C357.3 164 352 146.6 352 128v0V32 12 10.7C352 4.8 356.7 .1 362.6 0h.2c3.3 0 6.4 1.6 8.4 4.2l0 .1L384 21.3l27.2 36.3L416 64h64l4.8-6.4L512 21.3 524.8 4.3l0-.1c2-2.6 5.1-4.2 8.4-4.2h.2C539.3 .1 544 4.8 544 10.7V12 32v96c0 17.3-4.6 33.6-12.6 47.6c-11.3 19.8-29.6 35.2-51.4 42.9zM432 128a16 16 0 1 0 -32 0 16 16 0 1 0 32 0zm48 16a16 16 0 1 0 0-32 16 16 0 1 0 0 32z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3531-field_13_2\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Chat\" aria-errormessage=\"wpforms-3531-field_13_2-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Chat<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3531-field_13_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M309.6 158.5L332.7 19.8C334.6 8.4 344.5 0 356.1 0c7.5 0 14.5 3.5 19 9.5L392 32h52.1c12.7 0 24.9 5.1 33.9 14.1L496 64h56c13.3 0 24 10.7 24 24v24c0 44.2-35.8 80-80 80H464 448 426.7l-5.1 30.5-112-64zM416 256.1L416 480c0 17.7-14.3 32-32 32H352c-17.7 0-32-14.3-32-32V364.8c-24 12.3-51.2 19.2-80 19.2s-56-6.9-80-19.2V480c0 17.7-14.3 32-32 32H96c-17.7 0-32-14.3-32-32V249.8c-28.8-10.9-51.4-35.3-59.2-66.5L1 167.8c-4.3-17.1 6.1-34.5 23.3-38.8s34.5 6.1 38.8 23.3l3.9 15.5C70.5 182 83.3 192 98 192h30 16H303.8L416 256.1zM464 80a16 16 0 1 0 -32 0 16 16 0 1 0 32 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3531-field_13_1\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Chien\" aria-errormessage=\"wpforms-3531-field_13_1-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Chien<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3531-field_13_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M448 238.1V160h16l9.8 19.6c12.5 25.1 42.2 36.4 68.3 26c20.5-8.2 33.9-28 33.9-50.1V80c0-19.1-8.4-36.3-21.7-48H560c8.8 0 16-7.2 16-16s-7.2-16-16-16H480 448C377.3 0 320 57.3 320 128H224 203.2 148.8c-30.7 0-57.6 16.3-72.5 40.8C33.2 174.5 0 211.4 0 256v56c0 13.3 10.7 24 24 24s24-10.7 24-24V256c0-13.4 6.6-25.2 16.7-32.5c1.6 13 6.3 25.4 13.6 36.4l28.2 42.4c8.3 12.4 6.4 28.7-1.2 41.6c-16.5 28-20.6 62.2-10 93.9l17.5 52.4c4.4 13.1 16.6 21.9 30.4 21.9h33.7c21.8 0 37.3-21.4 30.4-42.1l-20.8-62.5c-2.1-6.4-.5-13.4 4.3-18.2l12.7-12.7c13.2-13.2 20.6-31.1 20.6-49.7c0-2.3-.1-4.6-.3-6.9l84 24c4.1 1.2 8.2 2.1 12.3 2.8V480c0 17.7 14.3 32 32 32h32c17.7 0 32-14.3 32-32V315.7c19.2-19.2 31.5-45.7 32-75.7h0v-1.9zM496 64a16 16 0 1 1 0 32 16 16 0 1 1 0-32z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3531-field_13_3\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Cheval\" aria-errormessage=\"wpforms-3531-field_13_3-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Cheval<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-9 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3531-field_13_9\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"80\" height=\"64px\" viewBox=\"0 0 496 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M248 167.5l64.9 98.8H183.1l64.9-98.8zM496 256c0 136.9-111.1 248-248 248S0 392.9 0 256 111.1 8 248 8s248 111.1 248 248zm-99.8 82.7L248 115.5 99.8 338.7h30.4l33.6-51.7h168.6l33.6 51.7h30.2z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-3531-field_13_9\" class=\"wpforms-screen-reader-element\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Autre\" aria-errormessage=\"wpforms-3531-field_13_9-error\" required >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Autre<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3531-field_6-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Localisation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3531-field_6\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][6][address1]\" placeholder=\"Adresse\" aria-errormessage=\"wpforms-3531-field_6-error\" required><label for=\"wpforms-3531-field_6\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3531-field_6-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][6][city]\" placeholder=\"Ville\" aria-errormessage=\"wpforms-3531-field_6-city-error\" required><label for=\"wpforms-3531-field_6-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3531-field_6-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][6][state]\" placeholder=\"D\u00e9partement\" aria-errormessage=\"wpforms-3531-field_6-state-error\" required><label for=\"wpforms-3531-field_6-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3531-field_6-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][6][postal]\" placeholder=\"Code postal\" aria-errormessage=\"wpforms-3531-field_6-postal-error\" required><label for=\"wpforms-3531-field_6-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3531-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_2\">Message <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3531-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" placeholder=\"Quelle est la raison de votre demande ?\" aria-errormessage=\"wpforms-3531-field_2-error\" required><\/textarea><\/div><div id=\"wpforms-3531-field_3-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">Date \/ Heure de rendez-vous souhait\u00e9 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3531-field_3\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][3][date]\" aria-errormessage=\"wpforms-3531-field_3-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-3531-field_3\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-3531-field_3-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"H:i\" data-step=\"30\" data-rule-time24h=\"true\" data-min-time=\"16:00\" data-max-time=\"21:00\" data-rule-time-limit=\"true\" name=\"wpforms[fields][3][time]\" aria-errormessage=\"wpforms-3531-field_3-time-error\" required><label for=\"wpforms-3531-field_3-time\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Time<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3531-field_15-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"15\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3531-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_10\">Comment avez-vous entendu parler de nous ?<\/label><select id=\"wpforms-3531-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>---<\/option><option value=\"Internet\" >Internet<\/option><option value=\"Facebook\" >Facebook<\/option><option value=\"Famille, amis, voisins\" >Famille, amis, voisins<\/option><option value=\"Autre\" >Autre<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-3531-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3531-field_9\">Avez-vous un code de r\u00e9duction ?<\/label><input type=\"text\" id=\"wpforms-3531-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-3531-field_9-error\" ><\/div><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3531\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/369agara.com\/en\/wp-json\/wp\/v2\/pages\/4153\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3531\" class=\"wpforms-submit\" data-alt-text=\"Envoi en cours\" data-submit-text=\"Envoyer\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/369agara.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\t\t<\/div>\n\n\t\t\n<style>\n#section_1705967070 {\n  padding-top: 30px;\n  padding-bottom: 30px;\n}\n#section_1705967070 .ux-shape-divider--top svg {\n  height: 150px;\n  --divider-top-width: 100%;\n}\n#section_1705967070 .ux-shape-divider--bottom svg {\n  height: 150px;\n  --divider-width: 100%;\n}\n<\/style>\n\t<\/section>\n\t\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4153","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.1 (Yoast SEO v27.5) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Formulaire de demande de rendez-vous | Agara<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/369agara.com\/en\/formulaire-de-demande-de-rendez-vous\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire de demande de rendez-vous\" \/>\n<meta property=\"og:url\" content=\"https:\/\/369agara.com\/en\/formulaire-de-demande-de-rendez-vous\/\" \/>\n<meta property=\"og:site_name\" content=\"Agara\" \/>\n<meta property=\"article:modified_time\" content=\"2025-05-31T20:34:01+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/369agara.com\\\/formulaire-de-demande-de-rendez-vous\\\/\",\"url\":\"https:\\\/\\\/369agara.com\\\/formulaire-de-demande-de-rendez-vous\\\/\",\"name\":\"Formulaire de demande de rendez-vous | 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