{"id":1757,"date":"2022-03-04T11:23:42","date_gmt":"2022-03-04T16:23:42","guid":{"rendered":"https:\/\/procheaidantpourtous.ca\/papt-proche-aidant-pour-tous-contact\/"},"modified":"2024-05-14T15:47:27","modified_gmt":"2024-05-14T19:47:27","slug":"contact","status":"publish","type":"page","link":"https:\/\/procheaidantpourtous.ca\/en\/contact\/","title":{"rendered":"PAPT &#8211; Proche aidant pour tous &#8211; Contact"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1757\" class=\"elementor elementor-1757 elementor-185\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bbb2bf1 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"bbb2bf1\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-170d8b7\" data-id=\"170d8b7\" data-element_type=\"column\" data-e-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-3ecf6b4 elementor-widget elementor-widget-heading\" data-id=\"3ecf6b4\" data-element_type=\"widget\" data-e-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\">We can help you<\/h2>\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-18e55a28 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"18e55a28\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-95403f8\" data-id=\"95403f8\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-5552a318 animated-slow elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"5552a318\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInLeft&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Let's talk about your needs<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-208d1060 elementor-widget elementor-widget-heading\" data-id=\"208d1060\" data-element_type=\"widget\" data-e-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\">Do not hesitate to contact us for more information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12c27b7c elementor-widget elementor-widget-text-editor\" data-id=\"12c27b7c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Upon receipt of your request, a member of our team will contact you as soon as possible.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6e9f7bbc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6e9f7bbc\" data-element_type=\"section\" data-e-type=\"section\">\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-50 elementor-inner-column elementor-element elementor-element-5a0620b\" data-id=\"5a0620b\" data-element_type=\"column\" data-e-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-b5d030 elementor-view-framed elementor-shape-square elementor-widget elementor-widget-icon\" data-id=\"b5d030\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<i aria-hidden=\"true\" class=\"fas fa-book\"><\/i>\t\t\t<\/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-180d65a1 elementor-widget elementor-widget-heading\" data-id=\"180d65a1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Time slots available<br> <br>7 days a week <br> from 8:00 a.m. to 8:00 p.m.<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0d95493 elementor-position-inline-start elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"0d95493\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"tel:4383707278\" class=\"elementor-icon elementor-animation-grow\" tabindex=\"-1\" aria-label=\"(438) 370-7278\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"tel:4383707278\" >\n\t\t\t\t\t\t\t(438) 370-7278\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\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-63ed759f elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"63ed759f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\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<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-3526d287\" data-id=\"3526d287\" data-element_type=\"column\" data-e-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-4856ca58 elementor-view-framed elementor-shape-square elementor-widget elementor-widget-icon\" data-id=\"4856ca58\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<i aria-hidden=\"true\" class=\"far fa-clock\"><\/i>\t\t\t<\/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-41d0595e elementor-widget elementor-widget-heading\" data-id=\"41d0595e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Administrative hours<br><br>From Monday to Friday,<br>from 9:00 a.m. to 4:00 p.m.<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1bd1e26c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"1bd1e26c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\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\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-5b34fed elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5b34fed\" data-element_type=\"section\" data-e-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-e4bf643\" data-id=\"e4bf643\" data-element_type=\"column\" data-e-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-c5b7b0f elementor-widget elementor-widget-heading\" data-id=\"c5b7b0f\" data-element_type=\"widget\" data-e-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\">Sign up form<\/h2>\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-0491fc5 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0491fc5\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-169bd85\" data-id=\"169bd85\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-49b5228 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"49b5228\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New form\" aria-label=\"New form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1757\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"49b5228\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"PAPT - Proche aidant pour tous - Contact\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1757\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<h2>Contact Person<h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_30d26ae elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_30d26ae\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_30d26ae]\" id=\"form-field-field_30d26ae\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First name Last name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-phoneprincipal elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-phoneprincipal\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[phoneprincipal]\" id=\"form-field-phoneprincipal\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone Number\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_b7333f0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b7333f0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_b7333f0]\" id=\"form-field-field_b7333f0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"E-mail\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5e3d679 elementor-col-100\">\n\t\t\t\t\t<h4>Resource person #1<\/h4>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2d8e901 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2d8e901\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2d8e901]\" id=\"form-field-field_2d8e901\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First name Last name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4b62a63 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b62a63\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_4b62a63]\" id=\"form-field-field_4b62a63\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone Number\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5df13a7 elementor-col-100\">\n\t\t\t\t\t<h4>Resource person #2<\/h4>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_632702e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_632702e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_632702e]\" id=\"form-field-field_632702e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First name Last name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_c53735e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c53735e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_c53735e]\" id=\"form-field-field_c53735e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone Number\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5dfa734 elementor-col-100\">\n\t\t\t\t\t<h2>Contact details of the person to be visited <\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_82d6360 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_82d6360\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTitle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mr.\" id=\"form-field-field_82d6360-0\" name=\"form_fields[field_82d6360][]\"> <label for=\"form-field-field_82d6360-0\">Mr.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ms.\" id=\"form-field-field_82d6360-1\" name=\"form_fields[field_82d6360][]\"> <label for=\"form-field-field_82d6360-1\">Ms.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_cf0aec2 elementor-col-75 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cf0aec2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_cf0aec2]\" id=\"form-field-field_cf0aec2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First name Last name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_22751ed elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_22751ed\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_22751ed]\" id=\"form-field-field_22751ed\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_50a8117 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_50a8117\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_50a8117]\" id=\"form-field-field_50a8117\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b88884d elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b88884d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStreet Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b88884d]\" id=\"form-field-field_b88884d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Street Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_24ad9f6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_24ad9f6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAppartment #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_24ad9f6]\" id=\"form-field-field_24ad9f6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Appartment #\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_29523d3 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_29523d3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_29523d3]\" id=\"form-field-field_29523d3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3b24526 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b24526\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostal Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3b24526]\" id=\"form-field-field_3b24526\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postal Code\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_4f6bf47 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4f6bf47\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tType of residence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_4f6bf47]\" id=\"form-field-field_4f6bf47\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"House\/Condo\/Apartment\">House\/Condo\/Apartment<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"CHSLD\/RPA\/RI\">CHSLD\/RPA\/RI<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_b7c1ff5 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b7c1ff5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHome phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_b7c1ff5]\" id=\"form-field-field_b7c1ff5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Home phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_53d08b5 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_53d08b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMobile phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_53d08b5]\" id=\"form-field-field_53d08b5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mobile phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_df3df87 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_df3df87\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHas animals at home\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_df3df87]\" id=\"form-field-field_df3df87\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Dogs\">Dogs<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cats\">Cats<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_b089507 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b089507\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow many animals do you have at home?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_b089507]\" id=\"form-field-field_b089507\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"0\">0<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"1\">1<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"2\">2<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"3\">3<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"4\">4<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"5\">5<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_312290b elementor-col-100\">\n\t\t\t\t\t<h2>Person's condition <\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_bbb4d05 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bbb4d05\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHygienic autonomy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_bbb4d05]\" id=\"form-field-field_bbb4d05\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Autonomous\">Autonomous<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Partial aid\">Partial aid<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Total help\">Total help<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_27b07f4 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27b07f4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlimentation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_27b07f4]\" id=\"form-field-field_27b07f4\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Autonomous\">Autonomous<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Partial aid\">Partial aid<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Total help\">Total help<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_80e2372 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_80e2372\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEyesight\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_80e2372]\" id=\"form-field-field_80e2372\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Good\">Good<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Average\">Average<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bad\">Bad<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_7b964bb elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7b964bb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGlasses\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_7b964bb]\" id=\"form-field-field_7b964bb\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_0f2cc7e elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0f2cc7e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHearing\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_0f2cc7e]\" id=\"form-field-field_0f2cc7e\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Good\">Good<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Average\">Average<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bad\">Bad<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_bc6d7b9 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bc6d7b9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHearing Device\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_bc6d7b9]\" id=\"form-field-field_bc6d7b9\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8c4b3c7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8c4b3c7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWalk\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8c4b3c7]\" id=\"form-field-field_8c4b3c7\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Autonomous\">Autonomous<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Marchette\">Marchette<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Wheelchair\">Wheelchair<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Don&#039;t get up\">Don&#039;t get up<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_e397dba elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e397dba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSafety device in the event of a fall\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_e397dba]\" id=\"form-field-field_e397dba\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_d53d357 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d53d357\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCardiac Problem\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_d53d357]\" id=\"form-field-field_d53d357\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Few\">Few<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_6b78deb elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6b78deb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDrives his\/her car\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_6b78deb]\" id=\"form-field-field_6b78deb\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_398e35d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_398e35d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTemperament\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_398e35d]\" id=\"form-field-field_398e35d\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Calm\">Calm<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Energetic\">Energetic<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_c6df0a8 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c6df0a8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPersonality\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_c6df0a8]\" id=\"form-field-field_c6df0a8\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Lonely\">Lonely<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sociable\">Sociable<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_db30dcc elementor-col-100\">\n\t\t\t\t\t<h2>Desired service(s)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_7facd50 elementor-col-50\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Sensorial stimulation\" id=\"form-field-field_7facd50-0\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-0\"> Sensorial stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Cognitive stimulation\" id=\"form-field-field_7facd50-1\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-1\"> Cognitive stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Social stimulation\" id=\"form-field-field_7facd50-2\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-2\"> Social stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Feeding aid\" id=\"form-field-field_7facd50-3\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-3\"> Feeding aid<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Games and leisure\" id=\"form-field-field_7facd50-4\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-4\"> Games and leisure<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Fun outings\" id=\"form-field-field_7facd50-5\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-5\"> Fun outings<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Help with wandering\" id=\"form-field-field_7facd50-6\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-6\"> Help with wandering<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Taking medication\" id=\"form-field-field_7facd50-7\" name=\"form_fields[field_7facd50][]\"> <label for=\"form-field-field_7facd50-7\"> Taking medication<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9038ca1 elementor-col-50\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Sensorial stimulation\" id=\"form-field-field_9038ca1-0\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-0\"> Sensorial stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Cognitive stimulation\" id=\"form-field-field_9038ca1-1\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-1\"> Cognitive stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Social stimulation\" id=\"form-field-field_9038ca1-2\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-2\"> Social stimulation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Feeding aid\" id=\"form-field-field_9038ca1-3\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-3\"> Feeding aid<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Games and leisure\" id=\"form-field-field_9038ca1-4\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-4\"> Games and leisure<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Fun outings\" id=\"form-field-field_9038ca1-5\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-5\"> Fun outings<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Help with wandering\" id=\"form-field-field_9038ca1-6\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-6\"> Help with wandering<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\" Taking medication\" id=\"form-field-field_9038ca1-7\" name=\"form_fields[field_9038ca1][]\"> <label for=\"form-field-field_9038ca1-7\"> Taking medication<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_425412e elementor-col-100\">\n\t\t\t\t\t<h2>Desired time slot(s)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a5fa6e5 elementor-col-50\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"1 time per week\" id=\"form-field-field_a5fa6e5-0\" name=\"form_fields[field_a5fa6e5][]\"> <label for=\"form-field-field_a5fa6e5-0\">1 time per week<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"2 times per week\" id=\"form-field-field_a5fa6e5-1\" name=\"form_fields[field_a5fa6e5][]\"> <label for=\"form-field-field_a5fa6e5-1\">2 times per week<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"3 times per week\" id=\"form-field-field_a5fa6e5-2\" name=\"form_fields[field_a5fa6e5][]\"> <label for=\"form-field-field_a5fa6e5-2\">3 times per week<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"4 times per week\" id=\"form-field-field_a5fa6e5-3\" name=\"form_fields[field_a5fa6e5][]\"> <label for=\"form-field-field_a5fa6e5-3\">4 times per week<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"5 times per week\" id=\"form-field-field_a5fa6e5-4\" name=\"form_fields[field_a5fa6e5][]\"> <label for=\"form-field-field_a5fa6e5-4\">5 times per week<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ddc25e1 elementor-col-50\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"1 hour per visit\" id=\"form-field-field_ddc25e1-0\" name=\"form_fields[field_ddc25e1][]\"> <label for=\"form-field-field_ddc25e1-0\">1 hour per visit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"2 hours per visit\" id=\"form-field-field_ddc25e1-1\" name=\"form_fields[field_ddc25e1][]\"> <label for=\"form-field-field_ddc25e1-1\">2 hours per visit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"3 hours per visit\" id=\"form-field-field_ddc25e1-2\" name=\"form_fields[field_ddc25e1][]\"> <label for=\"form-field-field_ddc25e1-2\">3 hours per visit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"4 hours per visit\" id=\"form-field-field_ddc25e1-3\" name=\"form_fields[field_ddc25e1][]\"> <label for=\"form-field-field_ddc25e1-3\">4 hours per visit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"5 hours per visit\" id=\"form-field-field_ddc25e1-4\" name=\"form_fields[field_ddc25e1][]\"> <label for=\"form-field-field_ddc25e1-4\">5 hours per visit<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8d92371 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8d92371\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Clarifications and additional notes.<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8d92371]\" id=\"form-field-field_8d92371\" rows=\"5\" placeholder=\"Your message\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm elementor-animation-float\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\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>We can help you Let&#8217;s talk about your needs Do not hesitate to contact us for more information Upon receipt of your request, a member of our team will contact you as soon as possible. Time slots available 7 days a week from 8:00 a.m. to 8:00 p.m. (438) 370-7278 Administrative hours From Monday to [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1757","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>PAPT - Proche aidant pour tous - Contact<\/title>\n<meta name=\"description\" content=\"The members of our team are happy to take care of your loved ones. The quality of our services is our main priority, and your trust is important to us. 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