{"id":1112,"date":"2020-09-23T23:14:24","date_gmt":"2020-09-23T23:14:24","guid":{"rendered":"https:\/\/bergewazirian.com\/?page_id=1112"},"modified":"2021-05-08T22:04:55","modified_gmt":"2021-05-08T22:04:55","slug":"refer","status":"publish","type":"page","link":"https:\/\/www.lesprosthodontistes.ca\/en\/refer\/","title":{"rendered":"Refer"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1112\" class=\"elementor elementor-1112\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-13e37a1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"13e37a1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b416b63\" data-id=\"b416b63\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-36bef92 noprint elementor-widget elementor-widget-spacer\" data-id=\"36bef92\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1e17d22 elementor-widget elementor-widget-html\" data-id=\"1e17d22\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"only-print\" style=\"\n\t\ttext-align:center; \n\t\twidth:100%;\n\t\tpadding-bottom:20px\"><img decoding=\"async\" src=\"\/wp-content\/uploads\/2020\/03\/Les-Prosthodontistes-Logo.jpg\" style=\"width:150px\">\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b4b06a4 referral-form-wrapper elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b4b06a4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-34009f5\" data-id=\"34009f5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fb05f31 elementor-widget elementor-widget-heading\" data-id=\"fb05f31\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Referral Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f2dfff elementor-list-item-link-inline elementor-align-center download-referral-form elementor-icon-list--layout-traditional elementor-widget elementor-widget-icon-list\" data-id=\"7f2dfff\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/wp-content\/uploads\/2021\/05\/Referral-Form.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-pdf\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Download Referral Form (PDF)<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2de8175 eael-contact-form-7-button-align-center referral-form eael-contact-form-7-button-custom elementor-widget elementor-widget-eael-contact-form-7\" data-id=\"2de8175\" data-element_type=\"widget\" data-widget_type=\"eael-contact-form-7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"eael-contact-form-7-wrapper\">\n                <div class=\"eael-contact-form eael-contact-form-7 eael-contact-form-2de8175 placeholder-show eael-contact-form-align-center\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1114-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1114\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1112#wpcf7-f1114-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=\"1114\" \/><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-f1114-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>* All fields are required\n<\/p>\n<p>The Prosthodontists:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prosthodontistes\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox chk-refer-drs\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Prosthodontistes\" value=\"Dr. Berge Wazirian\" \/><span class=\"wpcf7-list-item-label\">Dr. Berge Wazirian<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Prosthodontistes\" value=\"Dr. Mona Karazivan\" \/><span class=\"wpcf7-list-item-label\">Dr. Mona Karazivan<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Prosthodontistes\" value=\"Dr. Pierre G. Mackay\" \/><span class=\"wpcf7-list-item-label\">Dr. Pierre G. Mackay<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> From<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"from\"><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=\"from\" \/><\/span> <\/label>\n<\/p>\n<p><label> Dentist Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dentist-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=\"dentist-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Dentist Phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dentist-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=\"dentist-phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Patient Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient\"><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=\"patient\" \/><\/span> <\/label>\n<\/p>\n<p><label> Reason<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"reason\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/><input class=\"noprint\" type=\"submit\" value=\"Print\" onclick=\"window.print(); return false;\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n            <\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-41be105 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"41be105\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b4c61ff\" data-id=\"b4c61ff\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c2cb506 elementor-widget elementor-widget-spacer\" data-id=\"c2cb506\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-841c41e elementor-widget elementor-widget-html\" data-id=\"841c41e\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"only-print\" style=\"\n\t\ttext-align:center; \n\t\twidth:auto;\"><img decoding=\"async\" width=\"450px\" src=\"\/wp-content\/uploads\/2020\/11\/Referral_form_map.jpg\">\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c146b4f elementor-section-stretched elementor-section-full_width noprint elementor-section-height-default elementor-section-height-default\" data-id=\"c146b4f\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d720b0c\" data-id=\"d720b0c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fec9bbd elementor-widget elementor-widget-google_maps\" data-id=\"fec9bbd\" data-element_type=\"widget\" data-widget_type=\"google_maps.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-custom-embed\">\n\t\t\t<iframe loading=\"lazy\"\n\t\t\t\t\tsrc=\"https:\/\/maps.google.com\/maps?q=3550%20rue%20cote%20des%20neige%20h3h1v4&#038;t=m&#038;z=16&#038;output=embed&#038;iwloc=near\"\n\t\t\t\t\ttitle=\"3550 rue cote des neige h3h1v4\"\n\t\t\t\t\taria-label=\"3550 rue cote des neige h3h1v4\"\n\t\t\t><\/iframe>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Referral Form Download Referral Form (PDF) * All fields are required The Prosthodontists: Dr. Berge WazirianDr. Mona KarazivanDr. Pierre G. Mackay From Dentist Email Dentist Phone Patient Name Reason<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-pagebuilder-full-width.php","meta":{"footnotes":""},"class_list":["post-1112","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/pages\/1112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/comments?post=1112"}],"version-history":[{"count":5,"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/pages\/1112\/revisions"}],"predecessor-version":[{"id":1653,"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/pages\/1112\/revisions\/1653"}],"wp:attachment":[{"href":"https:\/\/www.lesprosthodontistes.ca\/en\/wp-json\/wp\/v2\/media?parent=1112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}