{"id":39250,"date":"2024-11-26T21:12:47","date_gmt":"2024-11-27T02:12:47","guid":{"rendered":"https:\/\/dormalab.com\/haleo-request\/"},"modified":"2025-12-11T12:44:27","modified_gmt":"2025-12-11T17:44:27","slug":"haleo-request","status":"publish","type":"page","link":"https:\/\/dormalab.com\/fr\/haleo-request\/","title":{"rendered":"Haleo Request"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"39250\" class=\"elementor elementor-39250 elementor-33909\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8628198 e-flex e-con-boxed e-con e-parent\" data-id=\"8628198\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-38f711bf e-flex e-con-boxed e-con e-parent\" data-id=\"38f711bf\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1daa0b01 elementor-widget elementor-widget-text-editor\" data-id=\"1daa0b01\" 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\tCe formulaire est destin\u00e9 \u00e0 l&rsquo;\u00e9quipe Haleo pour orienter les patients vers Dorma. Pour toute question, veuillez appeler <strong>le 514.360.7753<\/strong> . \n\n<strong>Instructions pour remplir le formulaire&nbsp;:<\/strong>\n<ol>\n \t<li>Remplissez tous les champs obligatoires avec la plus grande pr\u00e9cision possible.<\/li>\n \t<li>Soumettez le formulaire une fois que toutes les informations sont compl\u00e9t\u00e9es.<\/li>\n<\/ol>\n<strong>Remarque importante&nbsp;:<\/strong>\n Cette orientation permettra \u00e0 Dorma de comprendre les besoins du patient et d&rsquo;assurer un suivi appropri\u00e9.\n\n<strong>Garantie de confidentialit\u00e9&nbsp;:<\/strong>\n Toutes les informations relatives aux patients seront trait\u00e9es de mani\u00e8re confidentielle, conform\u00e9ment \u00e0 nos politiques de protection des donn\u00e9es.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a388182 elementor-widget elementor-widget-html\" data-id=\"a388182\" data-element_type=\"widget\" data-e-type=\"widget\" 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maxlength=\"80\" required=\"\">\n                <\/div>\n\n                <div class=\"mb-3\">\n                    <label for=\"phone\" class=\"form-label\">T\u00e9l\u00e9phone<\/label>\n                    <input type=\"tel\" id=\"phone\" name=\"phone\" class=\"form-control\" maxlength=\"40\" required=\"\">\n                <\/div>\n\n                <div class=\"mb-3\">\n                    <label for=\"00NOJ0000033TRx\" class=\"form-label\">Date de Naissance<\/label>\n                    <input type=\"date\" id=\"00NOJ0000033TRx\" name=\"00NOJ0000033TRx\" class=\"form-control\">\n                <\/div>\n\n                <div class=\"mb-3\">\n                    <label for=\"00NOJ0000033Tbd\" class=\"form-label\">Motif de la consultation du sommeil<\/label>\n                    <select id=\"00NOJ0000033Tbd\" name=\"00NOJ0000033Tbd\" class=\"form-select\">\n                        <option value=\"\">--Aucun--<\/option>\n <option value=\"Sleep Apnea\">Apn\u00e9e du sommeil<\/option>\n <option value=\"Snoring\">Ronflement<\/option>\n <option value=\"Fatigue \/ Insomnia\">Fatigue \/ Insomnie<\/option>\n <option value=\"Other\">Autre<\/option>\n                    <\/select>\n                <\/div>\n\n                <div class=\"mb-3\">\n                    <div class=\"g-recaptcha\" data-sitekey=\"6Ld6TCAcAAAAAERDQO5eRJNJ3PQ4qpb19E8-zWD7\"><\/div>\n                <\/div>\n\n                <button type=\"submit\" class=\"btn btn-primary w-100\">Soumettre<\/button>\n\n            <\/form>\n        <\/div>\n    <\/div>\n<\/div>\n\n<script>\n    \/\/ Bootstrap validation\n    (function () {\n        'use strict';\n        var forms = document.querySelectorAll('.needs-validation');\n        Array.prototype.slice.call(forms).forEach(function (form) {\n            form.addEventListener('submit', function (event) {\n                if (!form.checkValidity()) {\n                    event.preventDefault();\n                    event.stopPropagation();\n  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Pour toute question, veuillez appeler le 514.360.7753 . Instructions pour remplir le formulaire&nbsp;: Remplissez tous les champs obligatoires avec la plus grande pr\u00e9cision possible. Soumettez le formulaire une fois que toutes les informations sont compl\u00e9t\u00e9es. Remarque importante&nbsp;: Cette orientation permettra \u00e0 Dorma &#8230; <a title=\"Haleo Request\" class=\"read-more\" href=\"https:\/\/dormalab.com\/fr\/haleo-request\/\" aria-label=\"En savoir plus sur Haleo Request\">Lire la suite<\/a><\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-39250","page","type-page","status-publish"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Haleo Request - Dorma Sleep Clinics<\/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:\/\/dormalab.com\/fr\/haleo-request\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Haleo Request - Dorma Sleep Clinics\" \/>\n<meta property=\"og:description\" content=\"Ce formulaire est destin\u00e9 \u00e0 l&rsquo;\u00e9quipe Haleo pour orienter les patients vers Dorma. 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