{"id":1272,"date":"2025-05-30T21:49:54","date_gmt":"2025-05-31T01:49:54","guid":{"rendered":"https:\/\/www.helpforanxietydepression.com\/application-form\/"},"modified":"2025-08-18T17:50:55","modified_gmt":"2025-08-18T21:50:55","slug":"formulaire-de-candidature","status":"publish","type":"page","link":"https:\/\/www.helpforanxietydepression.com\/fr\/emploi\/formulaire-de-candidature\/","title":{"rendered":"Formulaire de candidature"},"content":{"rendered":"[vc_row type=\u00a0\u00bbfull_width_background\u00a0\u00bb full_screen_row_position=\u00a0\u00bbmiddle\u00a0\u00bb column_margin=\u00a0\u00bbdefault\u00a0\u00bb equal_height=\u00a0\u00bbyes\u00a0\u00bb content_placement=\u00a0\u00bbmiddle\u00a0\u00bb column_direction=\u00a0\u00bbdefault\u00a0\u00bb column_direction_tablet=\u00a0\u00bbcolumn_reverse\u00a0\u00bb column_direction_phone=\u00a0\u00bbcolumn_reverse\u00a0\u00bb scene_position=\u00a0\u00bbcenter\u00a0\u00bb top_padding=\u00a0\u00bb4%\u00a0\u00bb 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text=\u00a0\u00bbPossibilit\u00e9s d\u2019emploi\u00a0\u00bb font_container=\u00a0\u00bbtag:h5|text_align:left|color:%2365bc7b\u00a0\u00bb use_theme_fonts=\u00a0\u00bbyes\u00a0\u00bb css=\u00a0\u00bb\u00a0\u00bb][vc_custom_heading text=\u00a0\u00bbFormulaire de candidature\u00a0\u00bb use_theme_fonts=\u00a0\u00bbyes\u00a0\u00bb css=\u00a0\u00bb\u00a0\u00bb][divider line_type=\u00a0\u00bbFull Width Line\u00a0\u00bb line_thickness=\u00a0\u00bb1&Prime; divider_color=\u00a0\u00bbdefault\u00a0\u00bb custom_height=\u00a0\u00bb40&Prime;][vc_column_text css=\u00a0\u00bb\u00a0\u00bb text_direction=\u00a0\u00bbdefault\u00a0\u00bb]Nous croyons en des approches th\u00e9rapeutiques \u00e0 la fine pointe, combin\u00e9es \u00e0 des cliniciens attentionn\u00e9s, pour aider les gens \u00e0 transformer r\u00e9ellement leur vie.[\/vc_column_text][\/vc_column][vc_column column_padding=\u00a0\u00bbno-extra-padding\u00a0\u00bb column_padding_tablet=\u00a0\u00bbinherit\u00a0\u00bb 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class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_8' id='gform_8'  action='\/fr\/wp-json\/wp\/v2\/pages\/1272#gf_8' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_8_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Information personnelle<\/h3><\/div><fieldset id=\"field_8_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description 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           \n                            <span id='input_8_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_8_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_3_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_8_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_8_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_8_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_8_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_8_4_1' id='input_8_4_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_8_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_8_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_8_4_2' id='input_8_4_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_8_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_8_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_8_4_3' id='input_8_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_8_4_4_container' >\n                                        <select name='input_4.4' id='input_8_4_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_8_4_4' id='input_8_4_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_8_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_8_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_8_4_5' id='input_8_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_8_4_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_8_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_8'>T\u00e9l\u00e9phone (maison)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_8_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_9'>T\u00e9l\u00e9phone (maison)<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_8_9' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_10'>Cellulaire<\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_8_10' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_13'>Courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_8_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_8_14\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_14'>Site web<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_14' id='input_8_14' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_8_5\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_5'>Sexe<\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_8_5' class='large gfield_select'     aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_8_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional Information<\/h3><\/div><div id=\"field_8_7\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_7'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_7' id='input_8_7' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_8_7_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_8_7_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_8_7' class='gform_hidden' value='https:\/\/www.helpforanxietydepression.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_8_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_15'>Association(s) professionnelles:<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_8_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_16'>Num\u00e9ro de membre #:<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_8_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_17\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Re\u00e7us d\u2019assurance offerts (veuillez cocher tout ce qui s\u2019applique):<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_17'><div class='gchoice gchoice_8_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='OPQ'  id='choice_8_17_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_17_1' id='label_8_17_1' class='gform-field-label gform-field-label--type-inline'>OPQ<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='OTSTCFQ'  id='choice_8_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_17_2' id='label_8_17_2' class='gform-field-label gform-field-label--type-inline'>OTSTCFQ<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='OCCOQ'  id='choice_8_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_17_3' id='label_8_17_3' class='gform-field-label gform-field-label--type-inline'>OCCOQ<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='OPPQ'  id='choice_8_17_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_17_4' id='label_8_17_4' class='gform-field-label gform-field-label--type-inline'>OPPQ<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='ANN'  id='choice_8_17_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_17_5' id='label_8_17_5' class='gform-field-label gform-field-label--type-inline'>ANN<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Permis de psychoth\u00e9rapeute:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_18'>\n\t\t\t<div class='gchoice gchoice_8_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Oui'  id='choice_8_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_18_0' id='label_8_18_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Non'  id='choice_8_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_18_1' id='label_8_18_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_19'>Permit #:<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_8_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_20'>Nombre d\u2019ann\u00e9es de pratique:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_8_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Heures de bureau\/disponibilit\u00e9<\/h3><div class='gsection_description' id='gfield_description_8_21'>Veuillez indiquer vos jours et heures de disponibilit\u00e9 (incluant soirs et fins de semaine).<\/div><\/div><fieldset id=\"field_8_22\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du lundi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_22'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du lundi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_22'>\n                            <input type='number' name='input_22[]' id='input_8_22_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_22\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_22_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_22[]' id='input_8_22_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_22_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_23\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du lundi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_23'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le lundi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_23'>\n                            <input type='number' name='input_23[]' id='input_8_23_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_23\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_23_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_23[]' id='input_8_23_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_23_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_25\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du mardi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_25'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du mardi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_25'>\n                            <input type='number' name='input_25[]' id='input_8_25_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_25\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_25_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_25[]' id='input_8_25_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_25_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_24\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du mardi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_24'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le mardi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_24'>\n                            <input type='number' name='input_24[]' id='input_8_24_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_24\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_24_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_24[]' id='input_8_24_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_24_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_27\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du mercredi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_27'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du mercredi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_27'>\n                            <input type='number' name='input_27[]' id='input_8_27_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_27\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_27_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_27[]' id='input_8_27_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_27_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_26\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du mercredi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_26'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le mercredi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_26'>\n                            <input type='number' name='input_26[]' id='input_8_26_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_26\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_26_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_26[]' id='input_8_26_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_26_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_28\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du jeudi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_28'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du jeudi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_28'>\n                            <input type='number' name='input_28[]' id='input_8_28_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_28\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_28_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_28[]' id='input_8_28_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_28_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_29\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du jeudi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_29'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le jeudi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_29'>\n                            <input type='number' name='input_29[]' id='input_8_29_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_29\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_29_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_29[]' id='input_8_29_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_29_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_30\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du vendredi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_30'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du vendredi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_30'>\n                            <input type='number' name='input_30[]' id='input_8_30_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_30\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_30_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_30[]' id='input_8_30_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_30_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_31\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du vendredi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_31'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le vendredi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_31'>\n                            <input type='number' name='input_31[]' id='input_8_31_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_31\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_31_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_31[]' id='input_8_31_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_31_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_32\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du samedi \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_32'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du samedi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_32'>\n                            <input type='number' name='input_32[]' id='input_8_32_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_32\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_32_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_32[]' id='input_8_32_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_32_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_33\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du samedi \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_33'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le samedi.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_33'>\n                            <input type='number' name='input_33[]' id='input_8_33_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_33\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_33_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_33[]' id='input_8_33_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_33_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_34\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du dimanche \u2013 De<\/legend><div class='gfield_description' id='gfield_description_8_34'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle vous \u00eates disponible \u00e0 partir du dimanche.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_34'>\n                            <input type='number' name='input_34[]' id='input_8_34_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_34\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_34_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_34[]' id='input_8_34_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_34_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><fieldset id=\"field_8_35\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heures du dimanche \u2013 \u00c0<\/legend><div class='gfield_description' id='gfield_description_8_35'>S\u00e9lectionnez l\u2019heure \u00e0 laquelle se termine votre disponibilit\u00e9 le dimanche.<\/div><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_8_35'>\n                            <input type='number' name='input_35[]' id='input_8_35_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='false'   aria-describedby=\"gfield_description_8_35\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_8_35_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_35[]' id='input_8_35_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_8_35_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_8_36\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Internship Applications<\/h3><\/div><div id=\"field_8_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_37'>Pour les demandes de stage, veuillez pr\u00e9ciser le type de stage pour lequel vous postulez :<\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_8_37' class='large gfield_select'     aria-invalid=\"false\" ><option value='Stage pour permis de psychoth\u00e9rapie' >Stage pour permis de psychoth\u00e9rapie<\/option><option value='Stage en \u00e9quivalence OPQ' >Stage en \u00e9quivalence OPQ<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_8_38\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_38'>Autre(s) :<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_38' id='input_8_38' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dipl\u00f4mes universitaires<\/h3><div class='gsection_description' id='gfield_description_8_39'>Veuillez cocher tous les choix qui s\u2019appliquent<\/div><\/div><fieldset id=\"field_8_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher tous les choix qui s\u2019appliquent<\/legend><div class='gfield_description' id='gfield_description_8_41'> Veuillez cocher tous les choix qui s\u2019appliquent <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_41'><div class='gchoice gchoice_8_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='BA\/BSc.'  id='choice_8_41_1'   aria-describedby=\"gfield_description_8_41\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_1' id='label_8_41_1' class='gform-field-label gform-field-label--type-inline'>BA\/BSc.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='BSW'  id='choice_8_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_2' id='label_8_41_2' class='gform-field-label gform-field-label--type-inline'>BSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='BSN'  id='choice_8_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_3' id='label_8_41_3' class='gform-field-label gform-field-label--type-inline'>BSN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='MA\/MSc.'  id='choice_8_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_4' id='label_8_41_4' class='gform-field-label gform-field-label--type-inline'>MA\/MSc.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='MSW'  id='choice_8_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_5' id='label_8_41_5' class='gform-field-label gform-field-label--type-inline'>MSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.6' type='checkbox'  value='MD'  id='choice_8_41_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_6' id='label_8_41_6' class='gform-field-label gform-field-label--type-inline'>MD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.7' type='checkbox'  value='PhD.\/PsyD.'  id='choice_8_41_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_7' id='label_8_41_7' class='gform-field-label gform-field-label--type-inline'>PhD.\/PsyD.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.8' type='checkbox'  value='DSW'  id='choice_8_41_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_8' id='label_8_41_8' class='gform-field-label gform-field-label--type-inline'>DSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_41_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.9' type='checkbox'  value='Autre'  id='choice_8_41_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_41_9' id='label_8_41_9' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_42'>BA\/BSc.<\/label><div class='gfield_description' id='gfield_description_8_42'>Veuillez indiquer la discipline :<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_8_42' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_42\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_43'>MA\/MSc.<\/label><div class='gfield_description' id='gfield_description_8_43'>Veuillez indiquer la discipline : <\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_8_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_43\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_44'>PhD.\/PsyD.<\/label><div class='gfield_description' id='gfield_description_8_44'>Veuillez indiquer la discipline : <\/div><div class='ginput_container ginput_container_text'><input name='input_44' id='input_8_44' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_44\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_45'>Other<\/label><div class='gfield_description' id='gfield_description_8_45'>Veuillez indiquer la discipline :<\/div><div class='ginput_container ginput_container_text'><input name='input_45' id='input_8_45' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_45\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_46\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_46'>Formation(s) additionnelle(s)<\/label><div class='gfield_description' id='gfield_description_8_46'> (par ex., programme de perfectionnement post-gradu\u00e9, EMDR, hypnose, pour laquelle un dipl\u00f4me\/certificat a \u00e9t\u00e9 \u00e9mis.) <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_46' id='input_8_46' class='textarea large'  aria-describedby=\"gfield_description_8_46\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_49'>Assurance responsabilit\u00e9 professionnelle<\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_8_49' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_50'>Nom de l\u2019entreprise :<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_8_50' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Langues parl\u00e9es en contexte th\u00e9rapeutique<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_52'><div class='gchoice gchoice_8_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='Allemand'  id='choice_8_52_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_1' id='label_8_52_1' class='gform-field-label gform-field-label--type-inline'>Allemand<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Anglais'  id='choice_8_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_2' id='label_8_52_2' class='gform-field-label gform-field-label--type-inline'>Anglais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Arabe'  id='choice_8_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_3' id='label_8_52_3' class='gform-field-label gform-field-label--type-inline'>Arabe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='Arm\u00e9nien'  id='choice_8_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_4' id='label_8_52_4' class='gform-field-label gform-field-label--type-inline'>Arm\u00e9nien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='Autre(s)'  id='choice_8_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_5' id='label_8_52_5' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='Chinois'  id='choice_8_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_6' id='label_8_52_6' class='gform-field-label gform-field-label--type-inline'>Chinois<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='Cor\u00e9en'  id='choice_8_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_7' id='label_8_52_7' class='gform-field-label gform-field-label--type-inline'>Cor\u00e9en<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.8' type='checkbox'  value='Espagnol'  id='choice_8_52_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_8' id='label_8_52_8' class='gform-field-label gform-field-label--type-inline'>Espagnol<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.9' type='checkbox'  value='Farsi'  id='choice_8_52_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_9' id='label_8_52_9' class='gform-field-label gform-field-label--type-inline'>Farsi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.11' type='checkbox'  value='Fran\u00e7ais'  id='choice_8_52_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_11' id='label_8_52_11' class='gform-field-label gform-field-label--type-inline'>Fran\u00e7ais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.12' type='checkbox'  value='Grec'  id='choice_8_52_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_12' id='label_8_52_12' class='gform-field-label gform-field-label--type-inline'>Grec<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.13' type='checkbox'  value='Italien'  id='choice_8_52_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_13' id='label_8_52_13' class='gform-field-label gform-field-label--type-inline'>Italien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.14' type='checkbox'  value='Japonais'  id='choice_8_52_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_14' id='label_8_52_14' class='gform-field-label gform-field-label--type-inline'>Japonais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.15' type='checkbox'  value='N\u00e9erlandais'  id='choice_8_52_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_15' id='label_8_52_15' class='gform-field-label gform-field-label--type-inline'>N\u00e9erlandais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.16' type='checkbox'  value='Norv\u00e9gien'  id='choice_8_52_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_16' id='label_8_52_16' class='gform-field-label gform-field-label--type-inline'>Norv\u00e9gien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.17' type='checkbox'  value='Polonais'  id='choice_8_52_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_17' id='label_8_52_17' class='gform-field-label gform-field-label--type-inline'>Polonais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.18' type='checkbox'  value='Portugais'  id='choice_8_52_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_18' id='label_8_52_18' class='gform-field-label gform-field-label--type-inline'>Portugais<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.19' type='checkbox'  value='Russe'  id='choice_8_52_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_19' id='label_8_52_19' class='gform-field-label gform-field-label--type-inline'>Russe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.21' type='checkbox'  value='Serbo-croate'  id='choice_8_52_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_21' id='label_8_52_21' class='gform-field-label gform-field-label--type-inline'>Serbo-croate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.22' type='checkbox'  value='Su\u00e9dois'  id='choice_8_52_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_22' id='label_8_52_22' class='gform-field-label gform-field-label--type-inline'>Su\u00e9dois<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.23' type='checkbox'  value='Vietnamien'  id='choice_8_52_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_23' id='label_8_52_23' class='gform-field-label gform-field-label--type-inline'>Vietnamien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_52_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.24' type='checkbox'  value='Autre(s)'  id='choice_8_52_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_52_24' id='label_8_52_24' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_53'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_8_53' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Titre(s) professionnel(s)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_55'><div class='gchoice gchoice_8_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Art Th\u00e9rapeute'  id='choice_8_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_1' id='label_8_55_1' class='gform-field-label gform-field-label--type-inline'>Art Th\u00e9rapeute<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Counsellor'  id='choice_8_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_2' id='label_8_55_2' class='gform-field-label gform-field-label--type-inline'>Counsellor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='MFT'  id='choice_8_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_3' id='label_8_55_3' class='gform-field-label gform-field-label--type-inline'>MFT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='Th\u00e9rapeute en relation d\u2019aide'  id='choice_8_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_4' id='label_8_55_4' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapeute en relation d\u2019aide<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='Psychologue'  id='choice_8_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_5' id='label_8_55_5' class='gform-field-label gform-field-label--type-inline'>Psychologue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='Psychiatre'  id='choice_8_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_6' id='label_8_55_6' class='gform-field-label gform-field-label--type-inline'>Psychiatre<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.7' type='checkbox'  value='Infirmier\/\u00e8re'  id='choice_8_55_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_7' id='label_8_55_7' class='gform-field-label gform-field-label--type-inline'>Infirmier\/\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.8' type='checkbox'  value='Psychiatrist'  id='choice_8_55_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_8' id='label_8_55_8' class='gform-field-label gform-field-label--type-inline'>Psychiatrist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.9' type='checkbox'  value='Travailleur social'  id='choice_8_55_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_9' id='label_8_55_9' class='gform-field-label gform-field-label--type-inline'>Travailleur social<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.11' type='checkbox'  value='Psychoth\u00e9rapeute'  id='choice_8_55_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_11' id='label_8_55_11' class='gform-field-label gform-field-label--type-inline'>Psychoth\u00e9rapeute<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_55_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.12' type='checkbox'  value='Autre(s)'  id='choice_8_55_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_12' id='label_8_55_12' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_56'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_8_56' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_58\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Orientation(s) th\u00e9orique(s)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_58'><div class='gchoice gchoice_8_58_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='Comportementale'  id='choice_8_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_1' id='label_8_58_1' class='gform-field-label gform-field-label--type-inline'>Comportementale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.2' type='checkbox'  value='Cognitive'  id='choice_8_58_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_2' id='label_8_58_2' class='gform-field-label gform-field-label--type-inline'>Cognitive<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.3' type='checkbox'  value='\u00c9clectique\/Int\u00e9grative'  id='choice_8_58_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_3' id='label_8_58_3' class='gform-field-label gform-field-label--type-inline'>\u00c9clectique\/Int\u00e9grative<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.4' type='checkbox'  value='Existentielle'  id='choice_8_58_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_4' id='label_8_58_4' class='gform-field-label gform-field-label--type-inline'>Existentielle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.5' type='checkbox'  value='Humaniste'  id='choice_8_58_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_5' id='label_8_58_5' class='gform-field-label gform-field-label--type-inline'>Humaniste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.6' type='checkbox'  value='Post-Moderne'  id='choice_8_58_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_6' id='label_8_58_6' class='gform-field-label gform-field-label--type-inline'>Post-Moderne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.7' type='checkbox'  value='Psychoanalytique'  id='choice_8_58_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_7' id='label_8_58_7' class='gform-field-label gform-field-label--type-inline'>Psychoanalytique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.8' type='checkbox'  value='Psychodynamique'  id='choice_8_58_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_8' id='label_8_58_8' class='gform-field-label gform-field-label--type-inline'>Psychodynamique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.9' type='checkbox'  value='Syst\u00e9mique'  id='choice_8_58_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_9' id='label_8_58_9' class='gform-field-label gform-field-label--type-inline'>Syst\u00e9mique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_58_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.11' type='checkbox'  value='Autre(s)'  id='choice_8_58_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_58_11' id='label_8_58_11' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_59'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_8_59' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_60\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Domaines de sp\u00e9cialit\u00e9<\/h3><\/div><fieldset id=\"field_8_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Addictions<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_61'><div class='gchoice gchoice_8_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='Alcoolisme'  id='choice_8_61_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_1' id='label_8_61_1' class='gform-field-label gform-field-label--type-inline'>Alcoolisme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Enfants d\u2019une personne alcoolique'  id='choice_8_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_2' id='label_8_61_2' class='gform-field-label gform-field-label--type-inline'>Enfants d\u2019une personne alcoolique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Jeu compulsif'  id='choice_8_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_3' id='label_8_61_3' class='gform-field-label gform-field-label--type-inline'>Jeu compulsif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='D\u00e9pendance affective'  id='choice_8_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_4' id='label_8_61_4' class='gform-field-label gform-field-label--type-inline'>D\u00e9pendance affective<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Abus de substance \/ D\u00e9pendance'  id='choice_8_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_5' id='label_8_61_5' class='gform-field-label gform-field-label--type-inline'>Abus de substance \/ D\u00e9pendance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Autre(s)'  id='choice_8_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_61_6' id='label_8_61_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_62'>Autre(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_8_62' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_65\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Probl\u00e9matiques ciblant les adolescents<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_65'><div class='gchoice gchoice_8_65_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.1' type='checkbox'  value='Gestion de la col\u00e8re'  id='choice_8_65_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_1' id='label_8_65_1' class='gform-field-label gform-field-label--type-inline'>Gestion de la col\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.2' type='checkbox'  value='Intimidation'  id='choice_8_65_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_2' id='label_8_65_2' class='gform-field-label gform-field-label--type-inline'>Intimidation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.3' type='checkbox'  value='Identit\u00e9'  id='choice_8_65_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_3' id='label_8_65_3' class='gform-field-label gform-field-label--type-inline'>Identit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.4' type='checkbox'  value='Difficult\u00e9s d&#039;apprentissage'  id='choice_8_65_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_4' id='label_8_65_4' class='gform-field-label gform-field-label--type-inline'>Difficult\u00e9s d'apprentissage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.5' type='checkbox'  value='Automutilation'  id='choice_8_65_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_5' id='label_8_65_5' class='gform-field-label gform-field-label--type-inline'>Automutilation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.6' type='checkbox'  value='Identit\u00e9 sexuelle'  id='choice_8_65_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_6' id='label_8_65_6' class='gform-field-label gform-field-label--type-inline'>Identit\u00e9 sexuelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_65_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.7' type='checkbox'  value='Autre(s)'  id='choice_8_65_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_7' id='label_8_65_7' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_66'>Autre(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_8_66' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Troubles alimentaires<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_68'><div class='gchoice gchoice_8_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='Troubles alimentaires'  id='choice_8_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_1' id='label_8_68_1' class='gform-field-label gform-field-label--type-inline'>Troubles alimentaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_68_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='Anorexie'  id='choice_8_68_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_2' id='label_8_68_2' class='gform-field-label gform-field-label--type-inline'>Anorexie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_68_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.3' type='checkbox'  value='Trouble de l&#039;alimentation infantile Boulimie'  id='choice_8_68_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_3' id='label_8_68_3' class='gform-field-label gform-field-label--type-inline'>Trouble de l'alimentation infantile Boulimie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_68_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.4' type='checkbox'  value='Ob\u00e9sit\u00e9'  id='choice_8_68_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_4' id='label_8_68_4' class='gform-field-label gform-field-label--type-inline'>Ob\u00e9sit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_68_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.5' type='checkbox'  value='Autre(s)'  id='choice_8_68_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_5' id='label_8_68_5' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_69'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_8_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_71\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Troubles anxieux<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_71'><div class='gchoice gchoice_8_71_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.1' type='checkbox'  value='Agoraphobie'  id='choice_8_71_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_1' id='label_8_71_1' class='gform-field-label gform-field-label--type-inline'>Agoraphobie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.2' type='checkbox'  value='Anxi\u00e9t\u00e9 g\u00e9n\u00e9ralis\u00e9e'  id='choice_8_71_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_2' id='label_8_71_2' class='gform-field-label gform-field-label--type-inline'>Anxi\u00e9t\u00e9 g\u00e9n\u00e9ralis\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.3' type='checkbox'  value='Trouble obsessif compulsif'  id='choice_8_71_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_3' id='label_8_71_3' class='gform-field-label gform-field-label--type-inline'>Trouble obsessif compulsif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.4' type='checkbox'  value='Anxi\u00e9t\u00e9 de performance'  id='choice_8_71_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_4' id='label_8_71_4' class='gform-field-label gform-field-label--type-inline'>Anxi\u00e9t\u00e9 de performance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.5' type='checkbox'  value='Phobie\/Anxi\u00e9t\u00e9 sociale'  id='choice_8_71_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_5' id='label_8_71_5' class='gform-field-label gform-field-label--type-inline'>Phobie\/Anxi\u00e9t\u00e9 sociale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.6' type='checkbox'  value='Phobie sp\u00e9cifique'  id='choice_8_71_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_6' id='label_8_71_6' class='gform-field-label gform-field-label--type-inline'>Phobie sp\u00e9cifique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.7' type='checkbox'  value='Trouble panique'  id='choice_8_71_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_7' id='label_8_71_7' class='gform-field-label gform-field-label--type-inline'>Trouble panique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_71_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.8' type='checkbox'  value='Autre(s)'  id='choice_8_71_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_71_8' id='label_8_71_8' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_72'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_8_72' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_70\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_74\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Troubles du comportement<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_74'><div class='gchoice gchoice_8_74_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.1' type='checkbox'  value='TDA\/H'  id='choice_8_74_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_1' id='label_8_74_1' class='gform-field-label gform-field-label--type-inline'>TDA\/H<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_74_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.2' type='checkbox'  value='Adulte'  id='choice_8_74_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_2' id='label_8_74_2' class='gform-field-label gform-field-label--type-inline'>Adulte<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_74_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.3' type='checkbox'  value='Enfant'  id='choice_8_74_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_3' id='label_8_74_3' class='gform-field-label gform-field-label--type-inline'>Enfant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_74_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.4' type='checkbox'  value='Trouble des conduites'  id='choice_8_74_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_4' id='label_8_74_4' class='gform-field-label gform-field-label--type-inline'>Trouble des conduites<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_74_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.5' type='checkbox'  value='Trouble d\u2019opposition'  id='choice_8_74_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_5' id='label_8_74_5' class='gform-field-label gform-field-label--type-inline'>Trouble d\u2019opposition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_74_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.6' type='checkbox'  value='Autre(s)'  id='choice_8_74_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_74_6' id='label_8_74_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_75\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_75'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_8_75' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_73\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_77\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Probl\u00e9matiques reli\u00e9es aux maladies chroniques\/fin de vie<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_77'><div class='gchoice gchoice_8_77_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.1' type='checkbox'  value='VIH\/Sida'  id='choice_8_77_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_1' id='label_8_77_1' class='gform-field-label gform-field-label--type-inline'>VIH\/Sida<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.2' type='checkbox'  value='Alzheimer'  id='choice_8_77_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_2' id='label_8_77_2' class='gform-field-label gform-field-label--type-inline'>Alzheimer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.3' type='checkbox'  value='Cancer'  id='choice_8_77_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_3' id='label_8_77_3' class='gform-field-label gform-field-label--type-inline'>Cancer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.4' type='checkbox'  value='Fatigue chronique'  id='choice_8_77_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_4' id='label_8_77_4' class='gform-field-label gform-field-label--type-inline'>Fatigue chronique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.5' type='checkbox'  value='Fibromyalgie'  id='choice_8_77_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_5' id='label_8_77_5' class='gform-field-label gform-field-label--type-inline'>Fibromyalgie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.6' type='checkbox'  value='Lupus'  id='choice_8_77_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_6' id='label_8_77_6' class='gform-field-label gform-field-label--type-inline'>Lupus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.7' type='checkbox'  value='Scl\u00e9rose en plaques'  id='choice_8_77_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_7' id='label_8_77_7' class='gform-field-label gform-field-label--type-inline'>Scl\u00e9rose en plaques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.8' type='checkbox'  value='Gestion de la douleur'  id='choice_8_77_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_8' id='label_8_77_8' class='gform-field-label gform-field-label--type-inline'>Gestion de la douleur<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.9' type='checkbox'  value='Parkinson'  id='choice_8_77_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_9' id='label_8_77_9' class='gform-field-label gform-field-label--type-inline'>Parkinson<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.11' type='checkbox'  value='Autre(s)'  id='choice_8_77_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_11' id='label_8_77_11' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_78\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_78'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_8_78' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_76\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_80\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Probl\u00e8mes dans le couple<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_80'><div class='gchoice gchoice_8_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='Avortement'  id='choice_8_80_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_1' id='label_8_80_1' class='gform-field-label gform-field-label--type-inline'>Avortement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.2' type='checkbox'  value='Parents vieillissants'  id='choice_8_80_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_2' id='label_8_80_2' class='gform-field-label gform-field-label--type-inline'>Parents vieillissants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.3' type='checkbox'  value='Communication'  id='choice_8_80_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_3' id='label_8_80_3' class='gform-field-label gform-field-label--type-inline'>Communication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.4' type='checkbox'  value='Divorce'  id='choice_8_80_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_4' id='label_8_80_4' class='gform-field-label gform-field-label--type-inline'>Divorce<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.5' type='checkbox'  value='Dispute'  id='choice_8_80_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_5' id='label_8_80_5' class='gform-field-label gform-field-label--type-inline'>Dispute<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.6' type='checkbox'  value='Fertilit\u00e9'  id='choice_8_80_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_6' id='label_8_80_6' class='gform-field-label gform-field-label--type-inline'>Fertilit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.7' type='checkbox'  value='Infidelit\u00e9'  id='choice_8_80_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_7' id='label_8_80_7' class='gform-field-label gform-field-label--type-inline'>Infidelit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.8' type='checkbox'  value='Intimit\u00e9'  id='choice_8_80_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_8' id='label_8_80_8' class='gform-field-label gform-field-label--type-inline'>Intimit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.9' type='checkbox'  value='Vie Militaire et impact sur la famille'  id='choice_8_80_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_9' id='label_8_80_9' class='gform-field-label gform-field-label--type-inline'>Vie Militaire et impact sur la famille<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.11' type='checkbox'  value='Violance conjugale'  id='choice_8_80_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_11' id='label_8_80_11' class='gform-field-label gform-field-label--type-inline'>Violance conjugale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_80_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.12' type='checkbox'  value='Autre(s)'  id='choice_8_80_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_80_12' id='label_8_80_12' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Violance conjugale :<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_82'>\n\t\t\t<div class='gchoice gchoice_8_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='Agresseur'  id='choice_8_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_82_0' id='label_8_82_0' class='gform-field-label gform-field-label--type-inline'>Agresseur<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='Victime'  id='choice_8_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_82_1' id='label_8_82_1' class='gform-field-label gform-field-label--type-inline'>Victime<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_81'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_8_81' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_79\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_84\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Probl\u00e9matiques reli\u00e9es \u00e0 la parentalit\u00e9<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_84'><div class='gchoice gchoice_8_84_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.1' type='checkbox'  value='Adoption'  id='choice_8_84_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_1' id='label_8_84_1' class='gform-field-label gform-field-label--type-inline'>Adoption<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_84_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.2' type='checkbox'  value='Co-parentalit\u00e9'  id='choice_8_84_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_2' id='label_8_84_2' class='gform-field-label gform-field-label--type-inline'>Co-parentalit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_84_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.3' type='checkbox'  value='Monoparentalit\u00e9'  id='choice_8_84_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_3' id='label_8_84_3' class='gform-field-label gform-field-label--type-inline'>Monoparentalit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_84_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.4' type='checkbox'  value='Famille recompos\u00e9e'  id='choice_8_84_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_4' id='label_8_84_4' class='gform-field-label gform-field-label--type-inline'>Famille recompos\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_84_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.5' type='checkbox'  value='Grossesse non pr\u00e9vu'  id='choice_8_84_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_5' id='label_8_84_5' class='gform-field-label gform-field-label--type-inline'>Grossesse non pr\u00e9vu<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_84_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.6' type='checkbox'  value='Autre(s)'  id='choice_8_84_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_84_6' id='label_8_84_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_85'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_8_85' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_83\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_87\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Geriatric Issues<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_87'><div class='gchoice gchoice_8_87_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.1' type='checkbox'  value='Vieillissement'  id='choice_8_87_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_87_1' id='label_8_87_1' class='gform-field-label gform-field-label--type-inline'>Vieillissement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_87_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.2' type='checkbox'  value='Prise de la retraire'  id='choice_8_87_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_87_2' id='label_8_87_2' class='gform-field-label gform-field-label--type-inline'>Prise de la retraire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_87_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_87.3' type='checkbox'  value='Autre(s)'  id='choice_8_87_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_87_3' id='label_8_87_3' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_88'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_8_88' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_86\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_93\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Trauma<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_93'><div class='gchoice gchoice_8_93_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.1' type='checkbox'  value='Choc post-traumatique'  id='choice_8_93_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_1' id='label_8_93_1' class='gform-field-label gform-field-label--type-inline'>Choc post-traumatique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_93_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.2' type='checkbox'  value='Inceste'  id='choice_8_93_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_2' id='label_8_93_2' class='gform-field-label gform-field-label--type-inline'>Inceste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_93_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.3' type='checkbox'  value='Stress post-traumatique'  id='choice_8_93_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_3' id='label_8_93_3' class='gform-field-label gform-field-label--type-inline'>Stress post-traumatique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_93_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.4' type='checkbox'  value='Viol'  id='choice_8_93_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_4' id='label_8_93_4' class='gform-field-label gform-field-label--type-inline'>Viol<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_93_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.5' type='checkbox'  value='Abus sexuel'  id='choice_8_93_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_5' id='label_8_93_5' class='gform-field-label gform-field-label--type-inline'>Abus sexuel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_93_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_93.6' type='checkbox'  value='Autre(s)'  id='choice_8_93_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_93_6' id='label_8_93_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_94'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_8_94' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_92\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_96\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Humeur<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_96'><div class='gchoice gchoice_8_96_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.1' type='checkbox'  value='Trouble bipolaire'  id='choice_8_96_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_1' id='label_8_96_1' class='gform-field-label gform-field-label--type-inline'>Trouble bipolaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_96_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.2' type='checkbox'  value='Comportement suicidaire'  id='choice_8_96_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_2' id='label_8_96_2' class='gform-field-label gform-field-label--type-inline'>Comportement suicidaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_96_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.3' type='checkbox'  value='D\u00e9pression'  id='choice_8_96_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_3' id='label_8_96_3' class='gform-field-label gform-field-label--type-inline'>D\u00e9pression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_96_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.4' type='checkbox'  value='Deuil\/perte'  id='choice_8_96_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_4' id='label_8_96_4' class='gform-field-label gform-field-label--type-inline'>Deuil\/perte<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_96_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.5' type='checkbox'  value='D\u00e9pression post-partum'  id='choice_8_96_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_5' id='label_8_96_5' class='gform-field-label gform-field-label--type-inline'>D\u00e9pression post-partum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_96_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.6' type='checkbox'  value='Autre(s)'  id='choice_8_96_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_96_6' id='label_8_96_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_97\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_97'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_8_97' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_98\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_103\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Probl\u00e9matiques reli\u00e9es \u00e0 la famille d\u2019origine<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_103'><div class='gchoice gchoice_8_103_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.1' type='checkbox'  value='Probl\u00e9me d&#039;adoption'  id='choice_8_103_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_103_1' id='label_8_103_1' class='gform-field-label gform-field-label--type-inline'>Probl\u00e9me d'adoption<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_103_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.2' type='checkbox'  value='Divorce'  id='choice_8_103_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_103_2' id='label_8_103_2' class='gform-field-label gform-field-label--type-inline'>Divorce<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_103_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.3' type='checkbox'  value='Inceste'  id='choice_8_103_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_103_3' id='label_8_103_3' class='gform-field-label gform-field-label--type-inline'>Inceste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_103_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.4' type='checkbox'  value='Relations'  id='choice_8_103_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_103_4' id='label_8_103_4' class='gform-field-label gform-field-label--type-inline'>Relations<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_103_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.5' type='checkbox'  value='Autre(s)'  id='choice_8_103_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_103_5' id='label_8_103_5' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_104\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_104'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_8_104' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_101\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_106\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Sexualit\u00e9<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_106'><div class='gchoice gchoice_8_106_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.1' type='checkbox'  value='LGBT'  id='choice_8_106_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_106_1' id='label_8_106_1' class='gform-field-label gform-field-label--type-inline'>LGBT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_106_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.2' type='checkbox'  value='Identit\u00e9 de genre'  id='choice_8_106_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_106_2' id='label_8_106_2' class='gform-field-label gform-field-label--type-inline'>Identit\u00e9 de genre<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_106_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.3' type='checkbox'  value='Identit\u00e9 sexuelle'  id='choice_8_106_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_106_3' id='label_8_106_3' class='gform-field-label gform-field-label--type-inline'>Identit\u00e9 sexuelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_106_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.4' type='checkbox'  value='Dysfonctionnement sexuel'  id='choice_8_106_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_106_4' id='label_8_106_4' class='gform-field-label gform-field-label--type-inline'>Dysfonctionnement sexuel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_106_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.5' type='checkbox'  value='Autre(s)'  id='choice_8_106_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_106_5' id='label_8_106_5' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_108\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Dysfonctionnement sexuel :<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_108'>\n\t\t\t<div class='gchoice gchoice_8_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Homme'  id='choice_8_108_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_108_0' id='label_8_108_0' class='gform-field-label gform-field-label--type-inline'>Homme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Femme'  id='choice_8_108_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_108_1' id='label_8_108_1' class='gform-field-label gform-field-label--type-inline'>Femme<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_107\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_107'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_107' id='input_8_107' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_105\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_110\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Counselling de carri\u00e8re<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_110'><div class='gchoice gchoice_8_110_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.1' type='checkbox'  value='Counselling de carri\u00e8re'  id='choice_8_110_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_1' id='label_8_110_1' class='gform-field-label gform-field-label--type-inline'>Counselling de carri\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_110_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.2' type='checkbox'  value='Coaching ex\u00e9cutif'  id='choice_8_110_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_2' id='label_8_110_2' class='gform-field-label gform-field-label--type-inline'>Coaching ex\u00e9cutif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_110_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.3' type='checkbox'  value='Gestion carri\u00e8re\/vie personnelle'  id='choice_8_110_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_3' id='label_8_110_3' class='gform-field-label gform-field-label--type-inline'>Gestion carri\u00e8re\/vie personnelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_110_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.4' type='checkbox'  value='Augmentation de la productivit\u00e9'  id='choice_8_110_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_4' id='label_8_110_4' class='gform-field-label gform-field-label--type-inline'>Augmentation de la productivit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_110_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.5' type='checkbox'  value='Psychologie du sport'  id='choice_8_110_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_5' id='label_8_110_5' class='gform-field-label gform-field-label--type-inline'>Psychologie du sport<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_110_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.6' type='checkbox'  value='Autre(s)'  id='choice_8_110_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_110_6' id='label_8_110_6' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_111\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_111'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_111' id='input_8_111' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_109\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_113\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Croissance personnelle<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_113'><div class='gchoice gchoice_8_113_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.1' type='checkbox'  value='Gestion de la col\u00e8re'  id='choice_8_113_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_1' id='label_8_113_1' class='gform-field-label gform-field-label--type-inline'>Gestion de la col\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.2' type='checkbox'  value='Croissance \u00e9motionnelle'  id='choice_8_113_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_2' id='label_8_113_2' class='gform-field-label gform-field-label--type-inline'>Croissance \u00e9motionnelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.3' type='checkbox'  value='Probl\u00e8mes identitaires'  id='choice_8_113_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_3' id='label_8_113_3' class='gform-field-label gform-field-label--type-inline'>Probl\u00e8mes identitaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.4' type='checkbox'  value='Probl\u00e8mes relationnels'  id='choice_8_113_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_4' id='label_8_113_4' class='gform-field-label gform-field-label--type-inline'>Probl\u00e8mes relationnels<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.5' type='checkbox'  value='Estime de soi'  id='choice_8_113_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_5' id='label_8_113_5' class='gform-field-label gform-field-label--type-inline'>Estime de soi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.6' type='checkbox'  value='Arr\u00eat du tabagisme'  id='choice_8_113_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_6' id='label_8_113_6' class='gform-field-label gform-field-label--type-inline'>Arr\u00eat du tabagisme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.7' type='checkbox'  value='Spiritualit\u00e9'  id='choice_8_113_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_7' id='label_8_113_7' class='gform-field-label gform-field-label--type-inline'>Spiritualit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.8' type='checkbox'  value='Gestion du stress'  id='choice_8_113_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_8' id='label_8_113_8' class='gform-field-label gform-field-label--type-inline'>Gestion du stress<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_113_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.9' type='checkbox'  value='Autre(s)'  id='choice_8_113_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_113_9' id='label_8_113_9' class='gform-field-label gform-field-label--type-inline'>Autre(s)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_114\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_114'>Autre(s) :<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_8_114' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_112\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_116\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Troubles envahissants du d\u00e9veloppement<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_116'><div class='gchoice gchoice_8_116_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.1' type='checkbox'  value='Autisme'  id='choice_8_116_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_116_1' id='label_8_116_1' class='gform-field-label gform-field-label--type-inline'>Autisme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_116_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.2' type='checkbox'  value='Syndrome Asperger'  id='choice_8_116_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_116_2' id='label_8_116_2' class='gform-field-label gform-field-label--type-inline'>Syndrome Asperger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_116_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.3' type='checkbox'  value='Enfants'  id='choice_8_116_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_116_3' id='label_8_116_3' class='gform-field-label gform-field-label--type-inline'>Enfants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_116_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.4' type='checkbox'  value='Adult'  id='choice_8_116_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_116_4' id='label_8_116_4' class='gform-field-label gform-field-label--type-inline'>Adult<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_115\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_118\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_118'>Autres domaines de sp\u00e9cialit\u00e9<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_118' id='input_8_118' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_120\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_119\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >M\u00e9thodes de traitements<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_119'><div class='gchoice gchoice_8_119_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.1' type='checkbox'  value='12 \u00e9tapes'  id='choice_8_119_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_1' id='label_8_119_1' class='gform-field-label gform-field-label--type-inline'>12 \u00e9tapes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.2' type='checkbox'  value='Psychoth\u00e9rapie adl\u00e9rienne'  id='choice_8_119_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_2' id='label_8_119_2' class='gform-field-label gform-field-label--type-inline'>Psychoth\u00e9rapie adl\u00e9rienne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.3' type='checkbox'  value='Art Th\u00e9rapie'  id='choice_8_119_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_3' id='label_8_119_3' class='gform-field-label gform-field-label--type-inline'>Art Th\u00e9rapie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.4' type='checkbox'  value='Th\u00e9rapie br\u00e8ve'  id='choice_8_119_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_4' id='label_8_119_4' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie br\u00e8ve<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.5' type='checkbox'  value='Th\u00e9rapie br\u00e8ve'  id='choice_8_119_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_5' id='label_8_119_5' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie br\u00e8ve<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.6' type='checkbox'  value='Protection de la Jeunesse'  id='choice_8_119_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_6' id='label_8_119_6' class='gform-field-label gform-field-label--type-inline'>Protection de la Jeunesse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.7' type='checkbox'  value='Psychoth\u00e9rapie chr\u00e9tienne'  id='choice_8_119_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_7' id='label_8_119_7' class='gform-field-label gform-field-label--type-inline'>Psychoth\u00e9rapie chr\u00e9tienne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.8' type='checkbox'  value='Coaching'  id='choice_8_119_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_8' id='label_8_119_8' class='gform-field-label gform-field-label--type-inline'>Coaching<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.9' type='checkbox'  value='Th\u00e9rapie cognitivo-comportementale'  id='choice_8_119_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_9' id='label_8_119_9' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie cognitivo-comportementale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.11' type='checkbox'  value='Th\u00e9rapie de couple'  id='choice_8_119_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_11' id='label_8_119_11' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie de couple<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.12' type='checkbox'  value='Intervention de crise apr\u00e8s un incident traumatique'  id='choice_8_119_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_12' id='label_8_119_12' class='gform-field-label gform-field-label--type-inline'>Intervention de crise apr\u00e8s un incident traumatique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.13' type='checkbox'  value='Expertise psychol\u00e9gale pour la garde d\u2019enfants'  id='choice_8_119_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_13' id='label_8_119_13' class='gform-field-label gform-field-label--type-inline'>Expertise psychol\u00e9gale pour la garde d\u2019enfants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.14' type='checkbox'  value='Th\u00e9rapie par la dance'  id='choice_8_119_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_14' id='label_8_119_14' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie par la dance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.15' type='checkbox'  value='Th\u00e9rapie comportementale dialectique'  id='choice_8_119_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_15' id='label_8_119_15' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie comportementale dialectique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.16' type='checkbox'  value='Th\u00e9rapie de la r\u00e9alit\u00e9'  id='choice_8_119_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_16' id='label_8_119_16' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie de la r\u00e9alit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.17' type='checkbox'  value='EMDR'  id='choice_8_119_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_17' id='label_8_119_17' class='gform-field-label gform-field-label--type-inline'>EMDR<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.18' type='checkbox'  value='Th\u00e9rapie par la musique'  id='choice_8_119_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_18' id='label_8_119_18' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie par la musique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.19' type='checkbox'  value='Th\u00e9rapie narrative'  id='choice_8_119_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_19' id='label_8_119_19' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie narrative<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.21' type='checkbox'  value='Enseignement des pratiques parentales saines'  id='choice_8_119_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_21' id='label_8_119_21' class='gform-field-label gform-field-label--type-inline'>Enseignement des pratiques parentales saines<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.22' type='checkbox'  value='Counselling pastoral'  id='choice_8_119_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_22' id='label_8_119_22' class='gform-field-label gform-field-label--type-inline'>Counselling pastoral<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.23' type='checkbox'  value='Tests de personnalit\u00e9'  id='choice_8_119_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_23' id='label_8_119_23' class='gform-field-label gform-field-label--type-inline'>Tests de personnalit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.24' type='checkbox'  value='Th\u00e9rapie par le jeu'  id='choice_8_119_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_24' id='label_8_119_24' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie par le jeu<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.25' type='checkbox'  value='Psychoanalyse'  id='choice_8_119_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_25' id='label_8_119_25' class='gform-field-label gform-field-label--type-inline'>Psychoanalyse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.26' type='checkbox'  value='Hypnose \u00e9ricksonienne'  id='choice_8_119_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_26' id='label_8_119_26' class='gform-field-label gform-field-label--type-inline'>Hypnose \u00e9ricksonienne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.27' type='checkbox'  value='Psychoth\u00e9rapie existentielle'  id='choice_8_119_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_27' id='label_8_119_27' class='gform-field-label gform-field-label--type-inline'>Psychoth\u00e9rapie existentielle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.28' type='checkbox'  value='Th\u00e9rapie familiale'  id='choice_8_119_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_28' id='label_8_119_28' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie familiale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.29' type='checkbox'  value='Th\u00e9rapie f\u00e9ministe'  id='choice_8_119_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_29' id='label_8_119_29' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie f\u00e9ministe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.31' type='checkbox'  value='Th\u00e9rapie Gestalt'  id='choice_8_119_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_31' id='label_8_119_31' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie Gestalt<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.32' type='checkbox'  value='Th\u00e9rapie de groupe'  id='choice_8_119_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_32' id='label_8_119_32' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie de groupe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.33' type='checkbox'  value='Imagerie mentale'  id='choice_8_119_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_33' id='label_8_119_33' class='gform-field-label gform-field-label--type-inline'>Imagerie mentale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.34' type='checkbox'  value='Th\u00e9rapie holistique'  id='choice_8_119_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_34' id='label_8_119_34' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie holistique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.35' type='checkbox'  value='Hypnoth\u00e9rapie'  id='choice_8_119_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_35' id='label_8_119_35' class='gform-field-label gform-field-label--type-inline'>Hypnoth\u00e9rapie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.36' type='checkbox'  value='Th\u00e9rapie Intensive de couple'  id='choice_8_119_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_36' id='label_8_119_36' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie Intensive de couple<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.37' type='checkbox'  value='Tests d\u2019intelligence'  id='choice_8_119_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_37' id='label_8_119_37' class='gform-field-label gform-field-label--type-inline'>Tests d\u2019intelligence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.38' type='checkbox'  value='Psychoanalyse jungienne'  id='choice_8_119_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_38' id='label_8_119_38' class='gform-field-label gform-field-label--type-inline'>Psychoanalyse jungienne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.39' type='checkbox'  value='Th\u00e9rapie maritale'  id='choice_8_119_39'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_39' id='label_8_119_39' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie maritale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_41'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.41' type='checkbox'  value='M\u00e9diation'  id='choice_8_119_41'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_41' id='label_8_119_41' class='gform-field-label gform-field-label--type-inline'>M\u00e9diation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_42'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.42' type='checkbox'  value='Th\u00e9rapie des champs de pens\u00e9e'  id='choice_8_119_42'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_42' id='label_8_119_42' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie des champs de pens\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_43'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.43' type='checkbox'  value='\u00c9valuations psycho\u00e9ducatives'  id='choice_8_119_43'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_43' id='label_8_119_43' class='gform-field-label gform-field-label--type-inline'>\u00c9valuations psycho\u00e9ducatives<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_44'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.44' type='checkbox'  value='Traitement psychopharmacologique'  id='choice_8_119_44'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_44' id='label_8_119_44' class='gform-field-label gform-field-label--type-inline'>Traitement psychopharmacologique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_45'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.45' type='checkbox'  value='Tests psychom\u00e9triques'  id='choice_8_119_45'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_45' id='label_8_119_45' class='gform-field-label gform-field-label--type-inline'>Tests psychom\u00e9triques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_46'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.46' type='checkbox'  value='Th\u00e9rapie par le jeux de Sable'  id='choice_8_119_46'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_46' id='label_8_119_46' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie par le jeux de Sable<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_47'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.47' type='checkbox'  value='Th\u00e9rapie sexuelle'  id='choice_8_119_47'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_47' id='label_8_119_47' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie sexuelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_48'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.48' type='checkbox'  value='Th\u00e9rapie orient\u00e9e vers les solutions'  id='choice_8_119_48'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_48' id='label_8_119_48' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie orient\u00e9e vers les solutions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_49'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.49' type='checkbox'  value='\u00c9valuation pour abus de substance'  id='choice_8_119_49'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_49' id='label_8_119_49' class='gform-field-label gform-field-label--type-inline'>\u00c9valuation pour abus de substance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_119_51'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.51' type='checkbox'  value='Th\u00e9rapie par le Yoga'  id='choice_8_119_51'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_119_51' id='label_8_119_51' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie par le Yoga<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_121\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_8_122\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Types de client\u00e8les<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_122'><div class='gchoice gchoice_8_122_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.1' type='checkbox'  value='Adultes'  id='choice_8_122_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_1' id='label_8_122_1' class='gform-field-label gform-field-label--type-inline'>Adultes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.2' type='checkbox'  value='Adolescents'  id='choice_8_122_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_2' id='label_8_122_2' class='gform-field-label gform-field-label--type-inline'>Adolescents<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.3' type='checkbox'  value='Couples'  id='choice_8_122_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_3' id='label_8_122_3' class='gform-field-label gform-field-label--type-inline'>Couples<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.4' type='checkbox'  value='Familles'  id='choice_8_122_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_4' id='label_8_122_4' class='gform-field-label gform-field-label--type-inline'>Familles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.5' type='checkbox'  value='Groupes'  id='choice_8_122_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_5' id='label_8_122_5' class='gform-field-label gform-field-label--type-inline'>Groupes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.6' type='checkbox'  value='A\u00een\u00e9s'  id='choice_8_122_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_6' id='label_8_122_6' class='gform-field-label gform-field-label--type-inline'>A\u00een\u00e9s<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_122_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_122.7' type='checkbox'  value='Enfants'  id='choice_8_122_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_122_7' id='label_8_122_7' class='gform-field-label gform-field-label--type-inline'>Enfants<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_124\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_124'>\u00cates-vous ouverts \u00e0 rencontrer des clients mandat\u00e9s par la Cour ou r\u00e9f\u00e9r\u00e9s par la DPJ?<\/label><div class='ginput_container ginput_container_select'><select name='input_124' id='input_8_124' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_123\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_125\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Groupes<\/h3><div class='gsection_description' id='gfield_description_8_125'>Si vous animez des groupes th\u00e9rapeutiques ou psycho\u00e9ducatifs, veuillez inscrire un aper\u00e7u dans l\u2019espace ci-dessous.<\/div><\/div><div id=\"field_8_126\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_126'>1 - Titre<\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_8_126' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_127\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_127'>Br\u00e8ve description<\/label><div class='ginput_container ginput_container_text'><input name='input_127' id='input_8_127' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_128\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_128'>Crit\u00e8res de la client\u00e8le vis\u00e9e<\/label><div class='ginput_container ginput_container_text'><input name='input_128' id='input_8_128' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_129\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_129'>2 - Titre<\/label><div class='ginput_container ginput_container_text'><input name='input_129' id='input_8_129' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_130\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_130'>Br\u00e8ve description<\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_8_130' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_131\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_131'>Crit\u00e8res de la client\u00e8le vis\u00e9e<\/label><div class='ginput_container ginput_container_text'><input name='input_131' id='input_8_131' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_132\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_132'>3 - Titre<\/label><div class='ginput_container ginput_container_text'><input name='input_132' id='input_8_132' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_133\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_133'>Br\u00e8ve description<\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_8_133' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_134\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_134'>Crit\u00e8res de la client\u00e8le vis\u00e9e<\/label><div class='ginput_container ginput_container_text'><input name='input_134' id='input_8_134' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_135\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_138\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_138'>Offrez-vous de la th\u00e9rapie par t\u00e9l\u00e9phone?<\/label><div class='ginput_container ginput_container_select'><select name='input_138' id='input_8_138' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_139\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_139'>Seriez-vous ouvert \u00e0 faire de la th\u00e9rapie en ligne?<\/label><div class='ginput_container ginput_container_select'><select name='input_139' id='input_8_139' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_140\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_140'>Acceptez-vous de faire des rencontres \u00e0 domicile?<\/label><div class='ginput_container ginput_container_select'><select name='input_140' id='input_8_140' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_141\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_141'>Donnez-vous des ateliers ou autres formations reli\u00e9s \u00e0 vos domaines de sp\u00e9cialit\u00e9?<\/label><div class='ginput_container ginput_container_select'><select name='input_141' id='input_8_141' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_142\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_142'>\u00cates-vous int\u00e9ress\u00e9(e) \u00e0 donner des conf\u00e9rences \u00e9ducatives \u00e0 des groupes de la communaut\u00e9?<\/label><div class='ginput_container ginput_container_select'><select name='input_142' id='input_8_142' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_8_144\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_8_145\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_145'>Veuillez inscrire ci-dessous toute autre information pertinente que vous croyez appropri\u00e9e pour d\u00e9finir le type de r\u00e9f\u00e9rences que vous souhaiteriez le plus recevoir:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_145' id='input_8_145' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_146\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_146'>CV<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_146' id='input_8_146' type='file' class='large' aria-describedby=\"gfield_upload_rules_8_146 gfield_description_8_146\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_146'>Types de fichiers accept\u00e9s\u00a0: pdf, jpg, jpeg, png, Taille max. des fichiers\u00a0: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_8_146'><\/div> <\/div><div class='gfield_description' id='gfield_description_8_146'>Veuillez joindre votre CV<\/div><\/div><div id=\"field_8_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_147'>Signature du candidat:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_8_147' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_148\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consentement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_8_148' tabindex='0'>En soumettant ce formulaire, vous reconnaissez et consentez \u00e0 la collecte, au traitement et \u00e0 la conservation des renseignements personnels que vous fournissez. Cela inclut, sans s\u2019y limiter, votre nom, vos coordonn\u00e9es, vos qualifications et toute autre donn\u00e9e n\u00e9cessaire dans le cadre de cette demande ou de cette requ\u00eate.<br \/>\n<br \/>\nEn cliquant sur \u00ab Soumettre \u00bb, vous confirmez avoir lu, compris et accept\u00e9 les conditions de consentement ci-dessus.<\/div><div class='ginput_container ginput_container_consent'><input name='input_148.1' id='input_8_148_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_8_148\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_8_148_1' >J\u2019accepte<\/label><input type='hidden' name='input_148.2' value='J\u2019accepte' class='gform_hidden' \/><input type='hidden' name='input_148.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_8_149\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_149'>CAPTCHA<\/label><div id='input_8_149' class='ginput_container ginput_recaptcha' data-sitekey='6Lf3jAUcAAAAAKxNithMMEJRBd5HQNqWfowrU6rM'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_8' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Soumettre'  \/> <input type='hidden' name='gform_ajax' value='form_id=8&amp;title=&amp;description=&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=1602539ddf90da7c3e0899200af647f5' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_8' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_8' id='gform_theme_8' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_8' id='gform_style_settings_8' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_8' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='8' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='5sRg9daquC\/0wGa22P01IXz0Mx\/4ZBVb9rWAHDYvriu23wAm5ZTig+bEZpf1P+8OcuRJ9g51d2TXDYxhvnleGD+d0agAfl6lugMAOjfD+4U3hhI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_8' 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