{"id":5910,"date":"2020-07-14T00:10:47","date_gmt":"2020-07-14T07:10:47","guid":{"rendered":"https:\/\/stimrouter.com\/pain-quiz\/"},"modified":"2024-12-11T10:24:51","modified_gmt":"2024-12-11T17:24:51","slug":"pain-quiz","status":"publish","type":"page","link":"https:\/\/stimrouter.com\/fr\/pain-quiz\/","title":{"rendered":"Pain Quiz"},"content":{"rendered":"\n<div id=\"acf\/banner-block_657e05655e4130e85cb48f6a1a75b750\" class=\"pxblock pxblock--banner banner text-color--light height--short\">\n\t\n\t<div class=\"container\">\n\t\t\t\t\t<div class=\"banner__content\">\n\t\t\t\t<h1>Questionnaire sur la douleur chronique<\/h1>\n\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<img decoding=\"async\" class=\"banner__wave\" src=\"\/wp-content\/themes\/stimrouter\/assets\/images\/wave-image.svg\">\n\t<\/div>\n\n\n\n<style>\n\t@media (min-width: 768px) {\n\t\t.columns__row > .columns__column.columns__column--1 {\n\t\t\twidth: 100%;\n\t\t}\n\t}\n<\/style>\n\n<div id=\"acf\/columns-block_64b86a498db2e2e11c482b28f3a0ff4b\" class=\"pxblock pxblock--columns columns\">\n\t\n\t<div class=\"container\">\n\t\t\n\t\t<div class=\"columns__row\">\n\t\t\t\t\t\t\t<div class=\"columns__column columns__column--1\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"columns__content\">\n\t\t\t\t\t\t\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f7241-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"7241\">\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\/5910#wpcf7-f7241-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"7241\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7241-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<table class=\"quiz-form\">\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">Pr\u00e9nom<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">Nom de famille<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">De campagne<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"country\"><option value=\"USA\">USA<\/option><option value=\"Canada\">Canada<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"The Bahamas\">The Bahamas<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belize\">Belize<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Chile\">Chile<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominica Republic\">Dominica Republic<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Panama\">Panama<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent and The Grenadines\">Saint Vincent and The Grenadines<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Venezuela\">Venezuela<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">Code postal<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zip-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zip-code\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p>ZIP \/ Postal Code\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">E-mail<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">T\u00e9l\u00e9phone<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label class=\"required\">Depuis combien de temps souffrez-vous ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pain\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"pain\" aria-invalid=\"false\" name=\"pain\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Moins de 6 mois\">Moins de 6 mois<\/option><option value=\"6 mois - 1 an\">6 mois &#8211; 1 an<\/option><option value=\"1-2 ans\">1-2 ans<\/option><option value=\"Plus de 2 ans\">Plus de 2 ans<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Quelle est la cause de votre douleur ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cause-pain\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"cause-pain\" aria-invalid=\"false\" name=\"cause-pain\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Post-op\u00e9ratoire\">Post-op\u00e9ratoire<\/option><option value=\"Blessure\">Blessure<\/option><option value=\"Maladie\">Maladie<\/option><option value=\"Diab\u00e8te\">Diab\u00e8te<\/option><option value=\"Autre\">Autre<\/option><option value=\"Inconnu\">Inconnu<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Quel est votre niveau de douleur au cours d\u2019une journ\u00e9e moyenne ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"level-pain\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"level-pain\" aria-invalid=\"false\" name=\"level-pain\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t\t<p><small>Sur une \u00e9chelle de 1 \u00e0 10 \u2014 10 \u00e9tant le pire<\/small>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t<span class=\"wpcf7-form-control-wrap recaptcha\" data-name=\"recaptcha\"><span data-sitekey=\"6LfL22QqAAAAAH1xmP4oPng3KX0DzAc51zSYH5ok\" class=\"wpcf7-form-control wpcf7-recaptcha g-recaptcha\"><\/span>\r\n<noscript>\r\n\t<div class=\"grecaptcha-noscript\">\r\n\t\t<iframe loading=\"lazy\" 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aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":29,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":true,"footnotes":""},"class_list":["post-5910","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/pages\/5910","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/comments?post=5910"}],"version-history":[{"count":0,"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/pages\/5910\/revisions"}],"wp:attachment":[{"href":"https:\/\/stimrouter.com\/fr\/wp-json\/wp\/v2\/media?parent=5910"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}