{"id":14639,"date":"2025-08-05T07:12:22","date_gmt":"2025-08-05T13:12:22","guid":{"rendered":"https:\/\/inlinemedical.ca\/test-du-formulaire-pour-genouillere\/"},"modified":"2025-10-08T15:12:01","modified_gmt":"2025-10-08T21:12:01","slug":"test-du-formulaire-pour-genouillere","status":"publish","type":"page","link":"https:\/\/inlinemedical.ca\/fr\/test-du-formulaire-pour-genouillere\/","title":{"rendered":"Test du formulaire pour genouill\u00e8re"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1352px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Formulaire pour orth\u00e8se sur mesure<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/fr\/wp-json\/wp\/v2\/pages\/14639#gf_3' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_3_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Facturer \u00e0<\/h3><\/div><fieldset id=\"field_3_24\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Customer Account:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_3_24'>\n                            \n                            <span id='input_3_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_3_24_3' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                    <input type='text' name='input_24.3' id='input_3_24_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><div id=\"field_3_22\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_22'>Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_22' id='input_3_22' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_18'>T\u00e9l\u00e9phone :<\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_3_18' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_4\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Votre Address:<\/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_3_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_4_1_container' >\n                                        <label for='input_3_4_1' id='input_3_4_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                        <input type='text' name='input_4.1' id='input_3_4_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_4_2_container' >\n                                        <label for='input_3_4_2' id='input_3_4_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                        <input type='text' name='input_4.2' id='input_3_4_2' value=''    autocomplete=\"address-line2\" aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_4_3_container' >\n                                    <label for='input_3_4_3' id='input_3_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_4.3' id='input_3_4_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_4_4_container' >\n                                        <label for='input_3_4_4' id='input_3_4_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                        <select name='input_4.4' id='input_3_4_4'     aria-required='false'   autocomplete=\"address-level1\" ><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                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_4_5_container' >\n                                    <label for='input_3_4_5' id='input_3_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_4.5' id='input_3_4_5' value=''    aria-required='false'   autocomplete=\"postal-code\" \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_3_4_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_3_16\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse de livraison si diff\u00e9rente<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_16' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_16_1_container' >\n                                        <label for='input_3_16_1' id='input_3_16_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse<\/label>\n                                        <input type='text' name='input_16.1' id='input_3_16_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_16_3_container' >\n                                    <label for='input_3_16_3' id='input_3_16_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_16.3' id='input_3_16_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_16_4_container' >\n                                        <label for='input_3_16_4' id='input_3_16_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                        <select name='input_16.4' id='input_3_16_4'     aria-required='false'   autocomplete=\"address-level1\" ><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                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_16_5_container' >\n                                    <label for='input_3_16_5' id='input_3_16_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_16.5' id='input_3_16_5' value=''    aria-required='false'   autocomplete=\"postal-code\" \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_16.6' id='input_3_16_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_122\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_122'>Remarques\/Instructions sp\u00e9ciales:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_122' id='input_3_122' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations du patients<\/h3><\/div><fieldset id=\"field_3_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Patient Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'>\n                            \n                            <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_130\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_130'>Num\u00e9ro de bon de commande : (le cas \u00e9ch\u00e9ant)<\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_3_130' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_26'>\u00c2ge:<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_3_26' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_27'>Taille :<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_3_27' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_28'>Poids :<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_3_28' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Jambe affect\u00e9e :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_31'><div class='gchoice gchoice_3_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='Gauche'  id='choice_3_31_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_31_1' id='label_3_31_1' class='gform-field-label gform-field-label--type-inline'>Gauche<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='Droite'  id='choice_3_31_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_31_2' id='label_3_31_2' class='gform-field-label gform-field-label--type-inline'>Droite<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Sexe :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_32'><div class='gchoice gchoice_3_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Masculin'  id='choice_3_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_1' id='label_3_32_1' class='gform-field-label gform-field-label--type-inline'>Masculin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='F\u00e9minin'  id='choice_3_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_2' id='label_3_32_2' class='gform-field-label gform-field-label--type-inline'>F\u00e9minin<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_29'>Diagnostic :<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_3_29' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_30'>T\u00e9l\u00e9phone :<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_3_30' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Instability\/Deficiency:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_41'><div class='gchoice gchoice_3_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='LCA'  id='choice_3_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_1' id='label_3_41_1' class='gform-field-label gform-field-label--type-inline'>LCA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='LCP'  id='choice_3_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_2' id='label_3_41_2' class='gform-field-label gform-field-label--type-inline'>LCP<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='LCM\/LCL'  id='choice_3_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_3' id='label_3_41_3' class='gform-field-label gform-field-label--type-inline'>LCM\/LCL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='F\u00e9moro-patellaire'  id='choice_3_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_4' id='label_3_41_4' class='gform-field-label gform-field-label--type-inline'>F\u00e9moro-patellaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Aucun'  id='choice_3_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_5' id='label_3_41_5' class='gform-field-label gform-field-label--type-inline'>Aucun<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ost\u00e9oarthrite:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_42'><div class='gchoice gchoice_3_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='M\u00e9dial'  id='choice_3_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_1' id='label_3_42_1' class='gform-field-label gform-field-label--type-inline'>M\u00e9dial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Lat\u00e9ral'  id='choice_3_42_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_2' id='label_3_42_2' class='gform-field-label gform-field-label--type-inline'>Lat\u00e9ral<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informations sur l&#039;orth\u00e8se<\/h3><\/div><div id=\"field_3_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_50'>Type d&#039;orth\u00e8se:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_3_50' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Fusion' >Fusion<\/option><option value='Fusion Compact (Women)' >Fusion Compact (Women)<\/option><option value='Fusion XT' >Fusion XT<\/option><option value='X2K' >X2K<\/option><option value='X2K Compact' >X2K Compact<\/option><option value='Axiom' >Axiom<\/option><option value='Axiom-d' >Axiom-d<\/option><option value='Z12' >Z12<\/option><option value='Z12-D' >Z12-D<\/option><option value='Z12 OA' >Z12 OA<\/option><option value='Z12 OA ajustable' >Z12 OA ajustable<\/option><option value='Duo' >Duo<\/option><option value='Thruster legacy' >Thruster legacy<\/option><option value='Thruster RLF' >Thruster RLF<\/option><option value='20.50 rotule' >20.50 rotule<\/option><option value='Jet' >Jet<\/option><\/select><\/div><\/div><fieldset id=\"field_3_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Fusion<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_35'><div class='gchoice gchoice_3_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='Fusion charni\u00e8re standard - 01209'  id='choice_3_35_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_1' id='label_3_35_1' class='gform-field-label gform-field-label--type-inline'>Fusion charni\u00e8re standard - 01209<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.2' type='checkbox'  value='Fusion OA plus m\u00e9dial - 01222'  id='choice_3_35_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_2' id='label_3_35_2' class='gform-field-label gform-field-label--type-inline'>Fusion OA plus m\u00e9dial - 01222<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.3' type='checkbox'  value='Fusion OA plus lat\u00e9ral - 01303'  id='choice_3_35_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_3' id='label_3_35_3' class='gform-field-label gform-field-label--type-inline'>Fusion OA plus lat\u00e9ral - 01303<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_48\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Fusion compact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_48'><div class='gchoice gchoice_3_48_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.1' type='checkbox'  value='Fusion compact charni\u00e8re standard - 01214'  id='choice_3_48_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_48_1' id='label_3_48_1' class='gform-field-label gform-field-label--type-inline'>Fusion compact charni\u00e8re standard - 01214<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_48_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.2' type='checkbox'  value='Fusion compact OA plus - 01225'  id='choice_3_48_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_48_2' id='label_3_48_2' class='gform-field-label gform-field-label--type-inline'>Fusion compact OA plus - 01225<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_47\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Fusion XT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_47'><div class='gchoice gchoice_3_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='Fusion XT charni\u00e8re standard - 01215'  id='choice_3_47_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_47_1' id='label_3_47_1' class='gform-field-label gform-field-label--type-inline'>Fusion XT charni\u00e8re standard - 01215<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='Fusion XT OA plus - 01227'  id='choice_3_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_47_2' id='label_3_47_2' class='gform-field-label gform-field-label--type-inline'>Fusion XT OA plus - 01227<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-quarter gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Solus\u00ae m\u00e9dial<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_49'><div class='gchoice gchoice_3_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='Solus m\u00e9dial\u00ae OA plus'  id='choice_3_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_49_1' id='label_3_49_1' class='gform-field-label gform-field-label--type-inline'>Solus m\u00e9dial\u00ae OA plus<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-quarter gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >X2K<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_62'><div class='gchoice gchoice_3_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='X2K PTO avec charni\u00e8re ajustable - 20025'  id='choice_3_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_62_1' id='label_3_62_1' class='gform-field-label gform-field-label--type-inline'>X2K PTO avec charni\u00e8re ajustable - 20025<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_62_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.2' type='checkbox'  value='X2K sur mesure avec charni\u00e8re ajustable - 20002'  id='choice_3_62_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_62_2' id='label_3_62_2' class='gform-field-label gform-field-label--type-inline'>X2K sur mesure avec charni\u00e8re ajustable - 20002<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-quarter gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >X2K Compact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_63'><div class='gchoice gchoice_3_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='X2K Compact charni\u00e8re standard - 20019'  id='choice_3_63_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_63_1' id='label_3_63_1' class='gform-field-label gform-field-label--type-inline'>X2K Compact charni\u00e8re standard - 20019<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='X2K Compact charni\u00e8re ajustable - 20020'  id='choice_3_63_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_63_2' id='label_3_63_2' class='gform-field-label gform-field-label--type-inline'>X2K Compact charni\u00e8re ajustable - 20020<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_116\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-quarter gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Duo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_116'><div class='gchoice gchoice_3_116_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.1' type='checkbox'  value='Duo court - ED312000'  id='choice_3_116_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_116_1' id='label_3_116_1' class='gform-field-label gform-field-label--type-inline'>Duo court - ED312000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_116_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.2' type='checkbox'  value='Duo standard - ED112000'  id='choice_3_116_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_116_2' id='label_3_116_2' class='gform-field-label gform-field-label--type-inline'>Duo standard - ED112000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_117\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Thruster legacy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_117'><div class='gchoice gchoice_3_117_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_117.1' type='checkbox'  value='Thruster Legacy court - TA419000'  id='choice_3_117_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_117_1' id='label_3_117_1' class='gform-field-label gform-field-label--type-inline'>Thruster Legacy court - TA419000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_117_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_117.2' type='checkbox'  value='Thruster Legacy standard - TA409000'  id='choice_3_117_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_117_2' id='label_3_117_2' class='gform-field-label gform-field-label--type-inline'>Thruster Legacy standard - TA409000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_118\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Thruster RLF<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_118'><div class='gchoice gchoice_3_118_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_118.1' type='checkbox'  value='Thruster RLF court - AG061016'  id='choice_3_118_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_118_1' id='label_3_118_1' class='gform-field-label gform-field-label--type-inline'>Thruster RLF court - AG061016<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_118_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_118.2' type='checkbox'  value='Thruster RLF standard - AG061012'  id='choice_3_118_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_118_2' id='label_3_118_2' class='gform-field-label gform-field-label--type-inline'>Thruster RLF standard - AG061012<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_119\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >20.50 rotule<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_119'><div class='gchoice gchoice_3_119_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.1' type='checkbox'  value='20.50 Standard Magn\u00e9sium - AG060050'  id='choice_3_119_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_1' id='label_3_119_1' class='gform-field-label gform-field-label--type-inline'>20.50 Standard Magn\u00e9sium - AG060050<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.2' type='checkbox'  value='20.50 \u00c9tendu Magn\u00e9sium - AG060052'  id='choice_3_119_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_2' id='label_3_119_2' class='gform-field-label gform-field-label--type-inline'>20.50 \u00c9tendu Magn\u00e9sium - AG060052<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.3' type='checkbox'  value='20.50 Standard Magn\u00e9sium OA - AG060054'  id='choice_3_119_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_3' id='label_3_119_3' class='gform-field-label gform-field-label--type-inline'>20.50 Standard Magn\u00e9sium OA - AG060054<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.4' type='checkbox'  value='20.50 \u00c9tendu Magn\u00e9sium OA - AG060055'  id='choice_3_119_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_4' id='label_3_119_4' class='gform-field-label gform-field-label--type-inline'>20.50 \u00c9tendu Magn\u00e9sium OA - AG060055<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.5' type='checkbox'  value='20.50 Standard Aluminium - AG260050'  id='choice_3_119_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_5' id='label_3_119_5' class='gform-field-label gform-field-label--type-inline'>20.50 Standard Aluminium - AG260050<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.6' type='checkbox'  value='20.50 \u00c9tendu Aluminium - AG260052'  id='choice_3_119_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_6' id='label_3_119_6' class='gform-field-label gform-field-label--type-inline'>20.50 \u00c9tendu Aluminium - AG260052<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.7' type='checkbox'  value='20.50 Standard Aluminum OA - AG260454'  id='choice_3_119_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_7' id='label_3_119_7' class='gform-field-label gform-field-label--type-inline'>20.50 Standard Aluminum OA - AG260454<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_119_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_119.8' type='checkbox'  value='20.50 Extended Aluminum OA - AG260455'  id='choice_3_119_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_119_8' id='label_3_119_8' class='gform-field-label gform-field-label--type-inline'>20.50 Extended Aluminum OA - AG260455<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_133\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Axiom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_133'><div class='gchoice gchoice_3_133_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.1' type='checkbox'  value='Axiom Aluminium - PK424000'  id='choice_3_133_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_133_1' id='label_3_133_1' class='gform-field-label gform-field-label--type-inline'>Axiom Aluminium - PK424000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_133_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.2' type='checkbox'  value='Axiom Magn\u00e9sium - MG424000'  id='choice_3_133_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_133_2' id='label_3_133_2' class='gform-field-label gform-field-label--type-inline'>Axiom Magn\u00e9sium - MG424000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_134\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Axiom d<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_134'><div class='gchoice gchoice_3_134_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.1' type='checkbox'  value='Axiom-D Aluminium - PK428000'  id='choice_3_134_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_134_1' id='label_3_134_1' class='gform-field-label gform-field-label--type-inline'>Axiom-D Aluminium - PK428000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_134_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.2' type='checkbox'  value='Axiom-D Magn\u00e9sium - MG428000'  id='choice_3_134_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_134_2' id='label_3_134_2' class='gform-field-label gform-field-label--type-inline'>Axiom-D Magn\u00e9sium - MG428000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_150\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Z12<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_150'><div class='gchoice gchoice_3_150_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_150.1' type='checkbox'  value='Z12 Aluminum - AZ214000'  id='choice_3_150_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_150_1' id='label_3_150_1' class='gform-field-label gform-field-label--type-inline'>Z12 Aluminum - AZ214000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_150_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_150.2' type='checkbox'  value='Z12 Magnesium - AZ114000'  id='choice_3_150_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_150_2' id='label_3_150_2' class='gform-field-label gform-field-label--type-inline'>Z12 Magnesium - AZ114000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_137\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Z12 D<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_137'><div class='gchoice gchoice_3_137_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_137.1' type='checkbox'  value='Z12-D Aluminum - AZ228000'  id='choice_3_137_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_137_1' id='label_3_137_1' class='gform-field-label gform-field-label--type-inline'>Z12-D Aluminum - AZ228000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_137_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_137.2' type='checkbox'  value='Z12-D Magnesium - AZ128000'  id='choice_3_137_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_137_2' id='label_3_137_2' class='gform-field-label gform-field-label--type-inline'>Z12-D Magnesium - AZ128000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_138\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Z12 OA<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_138'><div class='gchoice gchoice_3_138_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_138.1' type='checkbox'  value='Z12 OA Aluminum - AZ215000'  id='choice_3_138_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_138_1' id='label_3_138_1' class='gform-field-label gform-field-label--type-inline'>Z12 OA Aluminum - AZ215000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_138_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_138.2' type='checkbox'  value='Z12 OA Magnesium - AZ115000'  id='choice_3_138_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_138_2' id='label_3_138_2' class='gform-field-label gform-field-label--type-inline'>Z12 OA Magnesium - AZ115000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_139\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Z12 OA ajustable<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_139'><div class='gchoice gchoice_3_139_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_139.1' type='checkbox'  value='Z12 OA Adjustable Aluminum - AZ215000-A'  id='choice_3_139_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_139_1' id='label_3_139_1' class='gform-field-label gform-field-label--type-inline'>Z12 OA Adjustable Aluminum - AZ215000-A<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_139_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_139.2' type='checkbox'  value='Z12 OA Adjustable Magnesium - AZ115000-A'  id='choice_3_139_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_139_2' id='label_3_139_2' class='gform-field-label gform-field-label--type-inline'>Z12 OA Adjustable Magnesium - AZ115000-A<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_151\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Jet<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_151'><div class='gchoice gchoice_3_151_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_151.1' type='checkbox'  value='Jet - KZ114000'  id='choice_3_151_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_151_1' id='label_3_151_1' class='gform-field-label gform-field-label--type-inline'>Jet - KZ114000<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_123\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/20-50-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; 20,50 couleurs\n<\/a><\/div><div id=\"field_3_124\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/fusion-brace-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; couleurs fusion\n<\/a><\/div><div id=\"field_3_125\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/axiom-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; couleurs axiom\n<\/a><\/div><div id=\"field_3_126\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/duo-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; couleurs duo\n<\/a><\/div><div id=\"field_3_127\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/thruster-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; couleurs thruster\n<\/a><\/div><div id=\"field_3_129\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/inlinemedical.ca\/product\/z12-colours\/\" target=\"_blank\" rel=\"noopener noreferrer\">\n Cliquez ici si le patient souhaite voir les couleurs -&gt; couleurs Z12\n<\/a><\/div><div id=\"field_3_154\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/a>\nColour Examples Coming Soon\n<\/a><\/div><fieldset id=\"field_3_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Options de couleur<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_56'><div class='gchoice gchoice_3_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Jet Black'  id='choice_3_56_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_1' id='label_3_56_1' class='gform-field-label gform-field-label--type-inline'>Jet Black<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='Gas Charcoal'  id='choice_3_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_2' id='label_3_56_2' class='gform-field-label gform-field-label--type-inline'>Gas Charcoal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='Vert for\u00eat'  id='choice_3_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_3' id='label_3_56_3' class='gform-field-label gform-field-label--type-inline'>Vert for\u00eat<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='Bleu marine'  id='choice_3_56_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_4' id='label_3_56_4' class='gform-field-label gform-field-label--type-inline'>Bleu marine<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.5' type='checkbox'  value='Orange'  id='choice_3_56_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_5' id='label_3_56_5' class='gform-field-label gform-field-label--type-inline'>Orange<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.6' type='checkbox'  value='Rose'  id='choice_3_56_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_6' id='label_3_56_6' class='gform-field-label gform-field-label--type-inline'>Rose<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.7' type='checkbox'  value='Rouge'  id='choice_3_56_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_7' id='label_3_56_7' class='gform-field-label gform-field-label--type-inline'>Rouge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.8' type='checkbox'  value='Bleu royal'  id='choice_3_56_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_8' id='label_3_56_8' class='gform-field-label gform-field-label--type-inline'>Bleu royal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_56_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.9' type='checkbox'  value='Jaune'  id='choice_3_56_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_56_9' id='label_3_56_9' class='gform-field-label gform-field-label--type-inline'>Jaune<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_120\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Options de couleur Bledsoe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_120'><div class='gchoice gchoice_3_120_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.1' type='checkbox'  value='Noir jet - 01'  id='choice_3_120_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_1' id='label_3_120_1' class='gform-field-label gform-field-label--type-inline'>Noir jet - 01<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.2' type='checkbox'  value='Ultramarine Blue - 11'  id='choice_3_120_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_2' id='label_3_120_2' class='gform-field-label gform-field-label--type-inline'>Ultramarine Blue - 11<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.3' type='checkbox'  value='Bleu trafic - 13'  id='choice_3_120_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_3' id='label_3_120_3' class='gform-field-label gform-field-label--type-inline'>Bleu trafic - 13<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.4' type='checkbox'  value='Vert mousse - 17'  id='choice_3_120_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_4' id='label_3_120_4' class='gform-field-label gform-field-label--type-inline'>Vert mousse - 17<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.5' type='checkbox'  value='Orange pur - 18'  id='choice_3_120_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_5' id='label_3_120_5' class='gform-field-label gform-field-label--type-inline'>Orange pur - 18<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.6' type='checkbox'  value='Telemagenta - 19'  id='choice_3_120_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_6' id='label_3_120_6' class='gform-field-label gform-field-label--type-inline'>Telemagenta - 19<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.7' type='checkbox'  value='Brown Red - 21'  id='choice_3_120_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_7' id='label_3_120_7' class='gform-field-label gform-field-label--type-inline'>Brown Red - 21<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.8' type='checkbox'  value='Rouge trafic - 22'  id='choice_3_120_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_8' id='label_3_120_8' class='gform-field-label gform-field-label--type-inline'>Rouge trafic - 22<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.9' type='checkbox'  value='Bleu eau - 23'  id='choice_3_120_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_9' id='label_3_120_9' class='gform-field-label gform-field-label--type-inline'>Bleu eau - 23<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.11' type='checkbox'  value='Blanc trafic - 24'  id='choice_3_120_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_11' id='label_3_120_11' class='gform-field-label gform-field-label--type-inline'>Blanc trafic - 24<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.12' type='checkbox'  value='Reed Green - 26'  id='choice_3_120_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_12' id='label_3_120_12' class='gform-field-label gform-field-label--type-inline'>Reed Green - 26<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.13' type='checkbox'  value='Pastel Violet - 27'  id='choice_3_120_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_13' id='label_3_120_13' class='gform-field-label gform-field-label--type-inline'>Pastel Violet - 27<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.14' type='checkbox'  value='Slate Gray - 28'  id='choice_3_120_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_14' id='label_3_120_14' class='gform-field-label gform-field-label--type-inline'>Slate Gray - 28<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.15' type='checkbox'  value='Gris trafic m\u00e9tallis\u00e9 - 29'  id='choice_3_120_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_15' id='label_3_120_15' class='gform-field-label gform-field-label--type-inline'>Gris trafic m\u00e9tallis\u00e9 - 29<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.16' type='checkbox'  value='Noir m\u00e9tallis\u00e9 - 33'  id='choice_3_120_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_16' id='label_3_120_16' class='gform-field-label gform-field-label--type-inline'>Noir m\u00e9tallis\u00e9 - 33<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.17' type='checkbox'  value='Argent m\u00e9tallis\u00e9 - 38'  id='choice_3_120_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_17' id='label_3_120_17' class='gform-field-label gform-field-label--type-inline'>Argent m\u00e9tallis\u00e9 - 38<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.18' type='checkbox'  value='Jaune signal - 46'  id='choice_3_120_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_18' id='label_3_120_18' class='gform-field-label gform-field-label--type-inline'>Jaune signal - 46<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.19' type='checkbox'  value='Bleu acier - 51'  id='choice_3_120_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_19' id='label_3_120_19' class='gform-field-label gform-field-label--type-inline'>Bleu acier - 51<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.21' type='checkbox'  value='Candy Purple - 77'  id='choice_3_120_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_21' id='label_3_120_21' class='gform-field-label gform-field-label--type-inline'>Candy Purple - 77<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_120_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.22' type='checkbox'  value='Light Pink - 78'  id='choice_3_120_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_120_22' id='label_3_120_22' class='gform-field-label gform-field-label--type-inline'>Light Pink - 78<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_156\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Fusion Color Options<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_156'><div class='gchoice gchoice_3_156_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.1' type='checkbox'  value='Charcoal (Default)'  id='choice_3_156_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_1' id='label_3_156_1' class='gform-field-label gform-field-label--type-inline'>Charcoal (Default)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.2' type='checkbox'  value='Black Metallic'  id='choice_3_156_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_2' id='label_3_156_2' class='gform-field-label gform-field-label--type-inline'>Black Metallic<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.3' type='checkbox'  value='Brown Red'  id='choice_3_156_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_3' id='label_3_156_3' class='gform-field-label gform-field-label--type-inline'>Brown Red<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.4' type='checkbox'  value='Candy Purple'  id='choice_3_156_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_4' id='label_3_156_4' class='gform-field-label gform-field-label--type-inline'>Candy Purple<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.5' type='checkbox'  value='Jet Black'  id='choice_3_156_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_5' id='label_3_156_5' class='gform-field-label gform-field-label--type-inline'>Jet Black<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.6' type='checkbox'  value='Light Pink'  id='choice_3_156_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_6' id='label_3_156_6' class='gform-field-label gform-field-label--type-inline'>Light Pink<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.7' type='checkbox'  value='Moss Green'  id='choice_3_156_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_7' id='label_3_156_7' class='gform-field-label gform-field-label--type-inline'>Moss Green<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.8' type='checkbox'  value='Pastel Violet'  id='choice_3_156_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_8' id='label_3_156_8' class='gform-field-label gform-field-label--type-inline'>Pastel Violet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.9' type='checkbox'  value='Pure Orange'  id='choice_3_156_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_9' id='label_3_156_9' class='gform-field-label gform-field-label--type-inline'>Pure Orange<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.11' type='checkbox'  value='Reed Green'  id='choice_3_156_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_11' id='label_3_156_11' class='gform-field-label gform-field-label--type-inline'>Reed Green<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.12' type='checkbox'  value='Signal Yellow'  id='choice_3_156_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_12' id='label_3_156_12' class='gform-field-label gform-field-label--type-inline'>Signal Yellow<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.13' type='checkbox'  value='Silver Metallic'  id='choice_3_156_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_13' id='label_3_156_13' class='gform-field-label gform-field-label--type-inline'>Silver Metallic<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.14' type='checkbox'  value='Slate Gray'  id='choice_3_156_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_14' id='label_3_156_14' class='gform-field-label gform-field-label--type-inline'>Slate Gray<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.15' type='checkbox'  value='Steel Blue'  id='choice_3_156_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_15' id='label_3_156_15' class='gform-field-label gform-field-label--type-inline'>Steel Blue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.16' type='checkbox'  value='Telemagenta'  id='choice_3_156_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_16' id='label_3_156_16' class='gform-field-label gform-field-label--type-inline'>Telemagenta<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.17' type='checkbox'  value='Traffic Blue'  id='choice_3_156_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_17' id='label_3_156_17' class='gform-field-label gform-field-label--type-inline'>Traffic Blue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.18' type='checkbox'  value='Traffic Gray Metallic'  id='choice_3_156_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_18' id='label_3_156_18' class='gform-field-label gform-field-label--type-inline'>Traffic Gray Metallic<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.19' type='checkbox'  value='Traffic Red'  id='choice_3_156_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_19' id='label_3_156_19' class='gform-field-label gform-field-label--type-inline'>Traffic Red<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.21' type='checkbox'  value='Traffic White'  id='choice_3_156_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_21' id='label_3_156_21' class='gform-field-label gform-field-label--type-inline'>Traffic White<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.22' type='checkbox'  value='Ultra Marine Blue'  id='choice_3_156_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_22' id='label_3_156_22' class='gform-field-label gform-field-label--type-inline'>Ultra Marine Blue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_156_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_156.23' type='checkbox'  value='Water Blue'  id='choice_3_156_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_156_23' id='label_3_156_23' class='gform-field-label gform-field-label--type-inline'>Water Blue<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_141\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Options de finition de couleur<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_141'><div class='gchoice gchoice_3_141_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_141.1' type='checkbox'  value='Finition brillante (standard)'  id='choice_3_141_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_141_1' id='label_3_141_1' class='gform-field-label gform-field-label--type-inline'>Finition brillante (standard)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_141_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_141.2' type='checkbox'  value='Matte Finish (Only for Aluminum)'  id='choice_3_141_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_141_2' id='label_3_141_2' class='gform-field-label gform-field-label--type-inline'>Matte Finish (Only for Aluminum)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_152\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Options de finition de couleur<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_152'><div class='gchoice gchoice_3_152_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.1' type='checkbox'  value='Gloss Finish'  id='choice_3_152_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_152_1' id='label_3_152_1' class='gform-field-label gform-field-label--type-inline'>Gloss Finish<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_152_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.2' type='checkbox'  value='Finition mate'  id='choice_3_152_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_152_2' id='label_3_152_2' class='gform-field-label gform-field-label--type-inline'>Finition mate<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Mesures du patient<\/h3><\/div><div id=\"field_3_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_33'>Mesures prises par :<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_3_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_34'>T\u00e9l\u00e9phone :<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_3_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_74\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">D\u00e9calage<\/h3><\/div><div id=\"field_3_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_81'>Compensation (Offset):<\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_3_81' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_143\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Largeur du genou<\/h3><\/div><div id=\"field_3_142\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_142'>Largeur du genou (en mm):<\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_3_142' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Circonf\u00e9rence<\/h3><\/div><div id=\"field_3_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_36'>Circonf\u00e9rence de la Cuisse (en pouce):<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_3_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_38'>Circonf\u00e9rence du Mollet (en pouce):<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_3_38' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_80\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Mesures m\u00e9dio-lat\u00e9rales suppl\u00e9mentaires pour la section Notes\/Texte - Ces measures a priorit\u00e9<\/h3><\/div><div id=\"field_3_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_76'>7&quot; au-dessus du centre de la rotule<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_3_76' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_79\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_79'>6&quot; au-dessus du centre de la rotule<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_3_79' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_77\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_77'>6&quot; en dessous du centre de la rotule<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_3_77' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_105\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mesures suppl\u00e9mentaires<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_105'><div class='gchoice gchoice_3_105_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.1' type='checkbox'  value='Mesure Bledsoe'  id='choice_3_105_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_105_1' id='label_3_105_1' class='gform-field-label gform-field-label--type-inline'>Mesure Bledsoe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_105_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.2' type='checkbox'  value='Outil tibial'  id='choice_3_105_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_105_2' id='label_3_105_2' class='gform-field-label gform-field-label--type-inline'>Outil tibial<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_83\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Planche Bledsoe<\/h3><\/div><div id=\"field_3_84\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_84'>A1<\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_3_84' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_85'>A2<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_3_85' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_95\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_95'>B1<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_3_95' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_91\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_91'>B2<\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_3_91' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_94'>C1<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_3_94' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_93'>C2<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_3_93' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_92\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_92'>D1<\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_3_92' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_90'>D2<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_3_90' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_89'>E1<\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_3_89' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_87\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_87'>E2<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_3_87' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_88'>F1<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_3_88' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_86\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_86'>F2<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_3_86' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_97\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_97'>G1<\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_3_97' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_96\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_96'>G2<\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_3_96' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_145\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Circonf\u00e9rence de Bledsoe<\/h3><\/div><div id=\"field_3_146\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_146'>7&quot; Au-dessus de KC:<\/label><div class='ginput_container ginput_container_text'><input name='input_146' id='input_3_146' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_149\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_149'>3&quot; Au-dessus de KC:<\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_3_149' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_148\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_148'>3&quot; En dessous de KC:<\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_3_148' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_147'>6&quot; 3&quot; en dessous de KCKC:<\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_3_147' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_82\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Outil tibial<\/h3><\/div><div id=\"field_3_98\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_98'>1<\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_3_98' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_101\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_101'>2<\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_3_101' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_103\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_103'>3<\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_3_103' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_102\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_102'>4<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_3_102' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_99'>5<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_3_99' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_104\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_104'>6<\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_3_104' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Accessoires d&#039;orth\u00e8se<\/h3><\/div><fieldset id=\"field_3_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Accessoires orth\u00e8se <\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_60'><div class='gchoice gchoice_3_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='Sous-manchon en coton'  id='choice_3_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_1' id='label_3_60_1' class='gform-field-label gform-field-label--type-inline'>Sous-manchon en coton<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.2' type='checkbox'  value='Sous-manchon en n\u00e9opr\u00e8ne'  id='choice_3_60_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_2' id='label_3_60_2' class='gform-field-label gform-field-label--type-inline'>Sous-manchon en n\u00e9opr\u00e8ne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.3' type='checkbox'  value='Coussin condylien en gel'  id='choice_3_60_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_3' id='label_3_60_3' class='gform-field-label gform-field-label--type-inline'>Coussin condylien en gel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.4' type='checkbox'  value='Surmanchon'  id='choice_3_60_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_4' id='label_3_60_4' class='gform-field-label gform-field-label--type-inline'>Surmanchon<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.5' type='checkbox'  value='Sangle en silicone (75070)'  id='choice_3_60_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_5' id='label_3_60_5' class='gform-field-label gform-field-label--type-inline'>Sangle en silicone (75070)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.6' type='checkbox'  value='Kit de coussinets (CK004012)'  id='choice_3_60_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_6' id='label_3_60_6' class='gform-field-label gform-field-label--type-inline'>Kit de coussinets (CK004012)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_60_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.7' type='checkbox'  value='Manchon de suspension'  id='choice_3_60_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_60_7' id='label_3_60_7' class='gform-field-label gform-field-label--type-inline'>Manchon de suspension<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_121\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Bledsoe Accessoire d&#039;orth\u00e8se:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_121'><div class='gchoice gchoice_3_121_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.1' type='checkbox'  value='Coussinet haute activit\u00e9'  id='choice_3_121_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_1' id='label_3_121_1' class='gform-field-label gform-field-label--type-inline'>Coussinet haute activit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.2' type='checkbox'  value='Coussinet de d\u00e9compression tibial'  id='choice_3_121_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_2' id='label_3_121_2' class='gform-field-label gform-field-label--type-inline'>Coussinet de d\u00e9compression tibial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.3' type='checkbox'  value='Coussinet de d\u00e9compression f\u00e9moral'  id='choice_3_121_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_3' id='label_3_121_3' class='gform-field-label gform-field-label--type-inline'>Coussinet de d\u00e9compression f\u00e9moral<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.4' type='checkbox'  value='Anneau en D'  id='choice_3_121_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_4' id='label_3_121_4' class='gform-field-label gform-field-label--type-inline'>Anneau en D<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.5' type='checkbox'  value='Sangles PCL'  id='choice_3_121_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_5' id='label_3_121_5' class='gform-field-label gform-field-label--type-inline'>Sangles PCL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.6' type='checkbox'  value='Sous-manchon en coton'  id='choice_3_121_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_6' id='label_3_121_6' class='gform-field-label gform-field-label--type-inline'>Sous-manchon en coton<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.7' type='checkbox'  value='Sous-manchon en n\u00e9opr\u00e8ne'  id='choice_3_121_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_7' id='label_3_121_7' class='gform-field-label gform-field-label--type-inline'>Sous-manchon en n\u00e9opr\u00e8ne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.8' type='checkbox'  value='Coussin condylien en gel'  id='choice_3_121_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_8' id='label_3_121_8' class='gform-field-label gform-field-label--type-inline'>Coussin condylien en gel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.9' type='checkbox'  value='Surmanchon'  id='choice_3_121_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_9' id='label_3_121_9' class='gform-field-label gform-field-label--type-inline'>Surmanchon<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.11' type='checkbox'  value='Sangle en silicone (75070)'  id='choice_3_121_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_11' id='label_3_121_11' class='gform-field-label gform-field-label--type-inline'>Sangle en silicone (75070)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.12' type='checkbox'  value='Kit de coussinets (CK004012)'  id='choice_3_121_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_12' id='label_3_121_12' class='gform-field-label gform-field-label--type-inline'>Kit de coussinets (CK004012)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_121_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.13' type='checkbox'  value='Sangle de suspension (76517)'  id='choice_3_121_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_121_13' id='label_3_121_13' class='gform-field-label gform-field-label--type-inline'>Sangle de suspension (76517)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_140\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_140'>T\u00e9l\u00e9chargement de fichier :<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_140' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_140&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_140&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_140&quot;,&quot;filelist&quot;:&quot;gform_preview_3_140&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/inlinemedical.ca\\\/fr\\\/?gf_page=e4fead1cd985279&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/inlinemedical.ca\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/inlinemedical.ca\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;67108864b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:140,&quot;_gform_file_upload_nonce_3_140&quot;:&quot;fb3ff32004&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_3_140&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_140' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_140' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_140\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_140'>Taille max. des fichiers\u00a0: 64 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_140'><\/ul> <div id='gform_preview_3_140' class='ginput_preview_list'><\/div><\/div><\/div><fieldset id=\"field_3_132\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Soumettez-vous un scan via l&#039;application Inline Medical ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_132'><div class='gchoice gchoice_3_132_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_132.1' type='checkbox'  value='Oui'  id='choice_3_132_1'   aria-describedby=\"gfield_description_3_132\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_132_1' id='label_3_132_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_132_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_132.2' type='checkbox'  value='Non'  id='choice_3_132_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_132_2' id='label_3_132_2' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_132'>Plus d'informations sur l'application ici.<\/div><\/fieldset><fieldset id=\"field_3_155\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Place this order on hold:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_155'><div class='gchoice gchoice_3_155_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_155.1' type='checkbox'  value='Yes'  id='choice_3_155_1'   aria-describedby=\"gfield_description_3_155\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_155_1' id='label_3_155_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_155_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_155.2' type='checkbox'  value='No'  id='choice_3_155_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_155_2' id='label_3_155_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_155'>By selecting this option, you confirm that this order should not be processed at this time. This is typically used when waiting on insurance approval or additional documentation.\n\nOnce you are ready to proceed, please email us at orders@inlinemedical.ca with your order details to have it released and processed.<\/div><\/fieldset><div id=\"field_3_144\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\nfunction openInlineMedicalScan() {\n  var now = new Date().getTime();\n  var timeout = 1500; \/\/ 1.5 seconds\n\n  \/\/ iOS app deep link scheme (placeholder - replace once confirmed)\n  var appLink = \"inlinemedicalscan:\/\/\";\n  var appStore = \"https:\/\/apps.apple.com\/ca\/app\/inline-medical-scan\/id6752010478\";\n\n  \/\/ Try to open the app\n  window.location = appLink;\n\n  \/\/ If it fails, fallback to the App Store\n  setTimeout(function () {\n    if (new Date().getTime() - now 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