{"id":2639,"date":"2024-03-26T14:11:48","date_gmt":"2024-03-26T18:11:48","guid":{"rendered":"https:\/\/lesdentistesspecialistes.com\/dentistes-referents\/"},"modified":"2024-06-05T16:35:29","modified_gmt":"2024-06-05T20:35:29","slug":"dentist-referral","status":"publish","type":"page","link":"https:\/\/lesdentistesspecialistes.com\/en\/dentist-referral\/","title":{"rendered":"Dentist referral"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2639\" class=\"elementor elementor-2639 elementor-2303\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0765085 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle parallax_section_no qode_elementor_container_no\" data-id=\"0765085\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ee2d313\" data-id=\"ee2d313\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-71f2f75 elementor-widget elementor-widget-heading\" data-id=\"71f2f75\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Dentist referral<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6b0883f elementor-section-boxed elementor-section-height-default elementor-section-height-default parallax_section_no qode_elementor_container_no\" data-id=\"6b0883f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-69bbbdd\" data-id=\"69bbbdd\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-375ac56 elementor-widget elementor-widget-heading\" data-id=\"375ac56\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Les dentistes sp\u00e9cialistes de Ch\u00e2teauguay<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2d85556 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2d85556\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marker-alt\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">139 Saint-Jean-Baptiste, suite 100 Ch\u00e2teauguay, QC J6K 3B1<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7dfb944 elementor-widget elementor-widget-heading\" data-id=\"7dfb944\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/goo.gl\/maps\/EogWZ4CbybE2\" target=\"_blank\">View on Google<\/a><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fdaa30a elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"fdaa30a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 448 512\"><path d=\"M0 64C0 28.7 28.7 0 64 0H384c35.3 0 64 28.7 64 64V448c0 35.3-28.7 64-64 64H64c-35.3 0-64-28.7-64-64V64zM256 448a32 32 0 1 0 -64 0 32 32 0 1 0 64 0zM384 64H64V384H384V64z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">450 201-1117<br>info@lesdentistesspecialistes.com<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-aee2667\" data-id=\"aee2667\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2c91db1 elementor-widget elementor-widget-heading\" data-id=\"2c91db1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Office Hours<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-60a48c1 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"60a48c1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-b0644e5 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"b0644e5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ffb4fa5 elementor-widget elementor-widget-heading\" data-id=\"ffb4fa5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">MONDAY<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5cdfe02 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"5cdfe02\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d1a3e2e elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"d1a3e2e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-dc7df0a e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"dc7df0a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-52c510b elementor-widget elementor-widget-heading\" data-id=\"52c510b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">8:00 am \u2013 4:00 pm<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-96d117d e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"96d117d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-a1abe6e e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"a1abe6e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b17326d elementor-widget elementor-widget-heading\" data-id=\"b17326d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">TUESDAY<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e83b71f e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"e83b71f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0a679ca elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"0a679ca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-373f6fa e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"373f6fa\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d6403fd elementor-widget elementor-widget-heading\" data-id=\"d6403fd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">8:00 am \u2013 4:00 pm<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c1226bf e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"c1226bf\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-f87e418 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"f87e418\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fb0ecb8 elementor-widget elementor-widget-heading\" data-id=\"fb0ecb8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">WEDNESDAY<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b852997 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"b852997\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fe6ed37 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"fe6ed37\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-296d8ad e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"296d8ad\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-70370b4 elementor-widget elementor-widget-heading\" data-id=\"70370b4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">8:00 am \u2013 4:00 pm<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-07ce02c e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"07ce02c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-b104e82 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"b104e82\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-617b4da elementor-widget elementor-widget-heading\" data-id=\"617b4da\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">THURSDAY<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-11f6558 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"11f6558\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d896955 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"d896955\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-94e64eb e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"94e64eb\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7b3e166 elementor-widget elementor-widget-heading\" data-id=\"7b3e166\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">8:00 am \u2013 4:00 pm<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-15de15e e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"15de15e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-acf9865 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"acf9865\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-259c3d3 elementor-widget elementor-widget-heading\" data-id=\"259c3d3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">FRIDAY<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-89cd280 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"89cd280\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1c100f6 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"1c100f6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6bb755f e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"6bb755f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-30fcea8 elementor-widget elementor-widget-heading\" data-id=\"30fcea8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">8:00 am \u2013 4:00 pm<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ae59025 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-parent\" data-id=\"ae59025\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-8d17eed e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"8d17eed\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3ec92c3 elementor-widget elementor-widget-heading\" data-id=\"3ec92c3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">SAT \/ SUN<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0e0cf97 e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"0e0cf97\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aae1293 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"aae1293\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7cc765b e-con-full e-flex parallax_section_no qode_elementor_container_no e-con e-child\" data-id=\"7cc765b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-95dc6a8 elementor-widget elementor-widget-heading\" data-id=\"95dc6a8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">FERM\u00c9<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e7ce3c4 elementor-section-boxed elementor-section-height-default elementor-section-height-default parallax_section_no qode_elementor_container_no\" data-id=\"e7ce3c4\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b4f8f4b\" data-id=\"b4f8f4b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-26168a5 elementor-widget elementor-widget-heading\" data-id=\"26168a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Refer a patient<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1f022e4 elementor-button-align-start elementor-widget elementor-widget-form\" data-id=\"1f022e4\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<template id=\"cfef_logic_data_1f022e4\" class=\"cfef_logic_data_js\" data-form-id=\"1f022e4\">{&quot;endodontic_treatment&quot;:{&quot;display_mode&quot;:&quot;show&quot;,&quot;fire_action&quot;:&quot;All&quot;,&quot;file_types&quot;:&quot;png&quot;,&quot;logic_data&quot;:[{&quot;cfef_logic_field_id&quot;:&quot;field_07bd3aa&quot;,&quot;cfef_logic_field_is&quot;:&quot;==&quot;,&quot;cfef_logic_compare_value&quot;:&quot;Endodontics&quot;,&quot;_id&quot;:&quot;7a0789c&quot;}]},&quot;oral_and_maxillo_facial_surgery_care&quot;:{&quot;display_mode&quot;:&quot;show&quot;,&quot;fire_action&quot;:&quot;All&quot;,&quot;file_types&quot;:&quot;png&quot;,&quot;logic_data&quot;:[{&quot;cfef_logic_field_id&quot;:&quot;field_07bd3aa&quot;,&quot;cfef_logic_field_is&quot;:&quot;==&quot;,&quot;cfef_logic_compare_value&quot;:&quot;Oral and Maxillofacial Surgery&quot;,&quot;_id&quot;:&quot;7a0789c&quot;}]},&quot;periodontal_care&quot;:{&quot;display_mode&quot;:&quot;show&quot;,&quot;fire_action&quot;:&quot;All&quot;,&quot;file_types&quot;:&quot;png&quot;,&quot;logic_data&quot;:[{&quot;cfef_logic_field_id&quot;:&quot;field_07bd3aa&quot;,&quot;cfef_logic_field_is&quot;:&quot;==&quot;,&quot;cfef_logic_compare_value&quot;:&quot;Periodontics&quot;,&quot;_id&quot;:&quot;7a0789c&quot;}]}}<\/template>\t\t<form class=\"elementor-form\" method=\"post\" name=\"dentistes r\u00e9f\u00e9rents EN\" aria-label=\"dentistes r\u00e9f\u00e9rents EN\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"2639\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"1f022e4\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Dentist referral - Les dentistes sp\u00e9cialistes de Ch\u00e2teauguay\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"2639\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name of the patient\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_7202c65 elementor-col-100\">\n\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_7202c65]\" id=\"form-field-field_7202c65\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone number of the patient\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b2dd51f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b2dd51f]\" id=\"form-field-field_b2dd51f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name of the dentist\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_738ecfb elementor-col-100\">\n\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_738ecfb]\" id=\"form-field-field_738ecfb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone number of the dentist\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_07bd3aa elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_07bd3aa]\" id=\"form-field-field_07bd3aa\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"- Select a service \/ speciality -\">- Select a service \/ speciality -<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Endodontics\">Endodontics<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oral and Maxillofacial Surgery \">Oral and Maxillofacial Surgery <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Periodontics\">Periodontics<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-endodontic_treatment elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-endodontic_treatment\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<h5><b>Endodontic treatment<\/b><\/h5><span style=\"font-size:14px\">Please note some treatments will not be done unless required.<\/span>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Root canal\" id=\"form-field-endodontic_treatment-0\" name=\"form_fields[endodontic_treatment][]\"> <label for=\"form-field-endodontic_treatment-0\">Root canal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Endodontic retreatment\" id=\"form-field-endodontic_treatment-1\" name=\"form_fields[endodontic_treatment][]\"> <label for=\"form-field-endodontic_treatment-1\">Endodontic retreatment<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Endodontic surgery\" id=\"form-field-endodontic_treatment-2\" name=\"form_fields[endodontic_treatment][]\"> <label for=\"form-field-endodontic_treatment-2\">Endodontic surgery<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Consultation\" id=\"form-field-endodontic_treatment-3\" name=\"form_fields[endodontic_treatment][]\"> <label for=\"form-field-endodontic_treatment-3\">Consultation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-endodontic_treatment-4\" name=\"form_fields[endodontic_treatment][]\"> <label for=\"form-field-endodontic_treatment-4\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-oral_and_maxillo_facial_surgery_care elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-oral_and_maxillo_facial_surgery_care\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<h5><b>Oral and Maxillo-facial Surgery care <\/b><h5>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tooth extraction\" id=\"form-field-oral_and_maxillo_facial_surgery_care-0\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-0\">Tooth extraction<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Wisdom teeth\" id=\"form-field-oral_and_maxillo_facial_surgery_care-1\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-1\">Wisdom teeth<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dental implant\" id=\"form-field-oral_and_maxillo_facial_surgery_care-2\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-2\">Dental implant<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bone graft\" id=\"form-field-oral_and_maxillo_facial_surgery_care-3\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-3\">Bone graft<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pathology &amp; biopsy\" id=\"form-field-oral_and_maxillo_facial_surgery_care-4\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-4\">Pathology & biopsy<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Temporomandibular joint disorders\" id=\"form-field-oral_and_maxillo_facial_surgery_care-5\" name=\"form_fields[oral_and_maxillo_facial_surgery_care][]\"> <label for=\"form-field-oral_and_maxillo_facial_surgery_care-5\">Temporomandibular joint disorders<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-periodontal_care elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-periodontal_care\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<h5><b>Periodontal care<\/b><h5>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Complete periodontal exam\" id=\"form-field-periodontal_care-0\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-0\">Complete periodontal exam<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Specific periodontal exam\" id=\"form-field-periodontal_care-1\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-1\">Specific periodontal exam<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Crown-lenghtening procedure\" id=\"form-field-periodontal_care-2\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-2\">Crown-lenghtening procedure<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dental implant\" id=\"form-field-periodontal_care-3\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-3\">Dental implant<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Reduction of periodontal pockets\" id=\"form-field-periodontal_care-4\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-4\">Reduction of periodontal pockets<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Gum graft\" id=\"form-field-periodontal_care-5\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-5\">Gum graft<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-periodontal_care-6\" name=\"form_fields[periodontal_care][]\"> <label for=\"form-field-periodontal_care-6\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ac9805a elementor-col-100\">\n\t\t\t\t\tSite(s)\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_97718e3 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"18 \" id=\"form-field-field_97718e3-0\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-0\">18 <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"17 \" id=\"form-field-field_97718e3-1\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-1\">17 <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"16\" id=\"form-field-field_97718e3-2\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-2\">16<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"15\" id=\"form-field-field_97718e3-3\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-3\">15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"14\" id=\"form-field-field_97718e3-4\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-4\">14<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"13\" id=\"form-field-field_97718e3-5\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-5\">13<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"12\" id=\"form-field-field_97718e3-6\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-6\">12<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"11\" id=\"form-field-field_97718e3-7\" name=\"form_fields[field_97718e3][]\"> <label for=\"form-field-field_97718e3-7\">11<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_190f00a elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"21\" id=\"form-field-field_190f00a-0\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-0\">21<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"22\" id=\"form-field-field_190f00a-1\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-1\">22<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"23\" id=\"form-field-field_190f00a-2\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-2\">23<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"24\" id=\"form-field-field_190f00a-3\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-3\">24<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"25\" id=\"form-field-field_190f00a-4\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-4\">25<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"26\" id=\"form-field-field_190f00a-5\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-5\">26<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"27\" id=\"form-field-field_190f00a-6\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-6\">27<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"28\" id=\"form-field-field_190f00a-7\" name=\"form_fields[field_190f00a][]\"> <label for=\"form-field-field_190f00a-7\">28<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_dc4e210 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"48\" id=\"form-field-field_dc4e210-0\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-0\">48<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"47\" id=\"form-field-field_dc4e210-1\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-1\">47<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"46\" id=\"form-field-field_dc4e210-2\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-2\">46<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"45\" id=\"form-field-field_dc4e210-3\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-3\">45<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"44\" id=\"form-field-field_dc4e210-4\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-4\">44<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"43\" id=\"form-field-field_dc4e210-5\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-5\">43<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"42\" id=\"form-field-field_dc4e210-6\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-6\">42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"41\" id=\"form-field-field_dc4e210-7\" name=\"form_fields[field_dc4e210][]\"> <label for=\"form-field-field_dc4e210-7\">41<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8cea4b5 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"31\" id=\"form-field-field_8cea4b5-0\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-0\">31<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"32\" id=\"form-field-field_8cea4b5-1\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-1\">32<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"33\" id=\"form-field-field_8cea4b5-2\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-2\">33<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"34\" id=\"form-field-field_8cea4b5-3\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-3\">34<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"35\" id=\"form-field-field_8cea4b5-4\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-4\">35<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"36\" id=\"form-field-field_8cea4b5-5\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-5\">36<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"37\" id=\"form-field-field_8cea4b5-6\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-6\">37<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"38\" id=\"form-field-field_8cea4b5-7\" name=\"form_fields[field_8cea4b5][]\"> <label for=\"form-field-field_8cea4b5-7\">38<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-details elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[details]\" id=\"form-field-details\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"More details about the patient\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-upload elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-upload\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRadiography, dental record, etc...\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[upload]\" id=\"form-field-upload\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input type='hidden' name='lang' value='en' \/><\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ac0d3d9 elementor-widget elementor-widget-html\" data-id=\"ac0d3d9\" 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