{"id":23421005,"date":"2026-07-27T10:36:55","date_gmt":"2026-07-27T08:36:55","guid":{"rendered":"https:\/\/www.desouches-chirurgien-esthetique.com\/?page_id=23421005"},"modified":"2026-09-30T03:23:40","modified_gmt":"2026-09-30T01:23:40","slug":"richiesta-di-consultazione-privata","status":"publish","type":"page","link":"https:\/\/www.desouches-chirurgien-esthetique.com\/it\/demande-de-consultation-privee\/","title":{"rendered":"Richiesta di consultazione privata"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; admin_label=\u00a0\u00bbsection\u00a0\u00bb _builder_version=\u00a0\u00bb4.16&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row use_custom_gutter=\u00a0\u00bbon\u00a0\u00bb gutter_width=\u00a0\u00bb2&Prime; _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb width=\u00a0\u00bb95%\u00a0\u00bb max_width=\u00a0\u00bb1400px\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.16&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][dipi_breadcrumbs bc_custom_home=\u00a0\u00bbon\u00a0\u00bb bc_home_text=\u00a0\u00bbAccueil\u00a0\u00bb bc_home_url=\u00a0\u00bb\/\u00a0\u00bb bc_home_icon=\u00a0\u00bbon\u00a0\u00bb bc_post_taxonomy=\u00a0\u00bbdipi_cpt_category\u00a0\u00bb bc_schema=\u00a0\u00bbon\u00a0\u00bb bc_separator_color=\u00a0\u00bb#000000&Prime; admin_label=\u00a0\u00bbPixel Breadcrumbs\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb items_font=\u00a0\u00bbMontserrat||||||||\u00a0\u00bb items_text_color=\u00a0\u00bb#000000&Prime; active_font=\u00a0\u00bbMontserrat|500|||||||\u00a0\u00bb custom_padding=\u00a0\u00bb||15px||false|false\u00a0\u00bb custom_css_bc_items_link=\u00a0\u00bbtext-decoration: underline;\u00a0\u00bb global_module=\u00a0\u00bb23418405&Prime; locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/dipi_breadcrumbs][et_pb_code _builder_version=\u00a0\u00bb4.27.7&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb hover_enabled=\u00a0\u00bb0&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb background_color=\u00a0\u00bb#f4f4f4&Prime; custom_padding=\u00a0\u00bb30px|40px|30px|40px|true|true\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime; border_width_all=\u00a0\u00bb1px\u00a0\u00bb]<div class='fluentform ff-default fluentform_wrapper_6 ffs_default_wrap'><form data-form_id=\"6\" id=\"fluentform_6\" class=\"frm-fluent-form fluent_form_6 ff-el-form-top ff_form_instance_6_1 ff-form-loading ff_has_v3_recptcha ffs_default\" data-form_instance=\"ff_form_instance_6_1\" method=\"POST\" data-recptcha_key=\"6LdAwnUaAAAAAKZfV0oVIKbWB_9yZADKB4SubQic\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Demande de consultation priv\u00e9e<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='23421005' \/><input type=\"hidden\" id=\"_fluentform_6_fluentformnonce\" name=\"_fluentform_6_fluentformnonce\" value=\"8e05513b55\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/it\/wp-json\/wp\/v2\/pages\/23421005\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_1\" ><div class=\"dcd-intro\"><h2>Demande de consultation priv\u00e9e<\/h2><p>Afin de vous orienter de mani\u00e8re personnalis\u00e9e, le cabinet vous invite \u00e0 compl\u00e9ter ce court questionnaire. Apr\u00e8s \u00e9tude de votre demande, notre \u00e9quipe vous recontactera afin d'organiser le rendez-vous le plus adapt\u00e9.<\/p><ul><li><strong>Quelques minutes<\/strong> suffisent \u2014 vous avancez \u00e0 votre rythme.<\/li><li><strong>Confidentiel.<\/strong> Vos informations sont \u00e9tudi\u00e9es par l'\u00e9quipe du cabinet, jamais diffus\u00e9es.<\/li><li><strong>Sans engagement.<\/strong> Ce questionnaire pr\u00e9pare l'\u00e9change, il ne remplace pas une consultation m\u00e9dicale.<\/li><\/ul><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Dans quel domaine se situe votre demande ?\">Dans quel domaine se situe votre demande ?<\/label><div class=\"ff-el-tooltip\" data-content=\"Votre projet\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_31ffefcdc4f8e9ce613502cf885e885c'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Visage &amp; regard\"  id='dans_quel_domaine_se_situe_votre_demande_3_31ffefcdc4f8e9ce613502cf885e885c' aria-label='Visage &amp; regard' aria-invalid='false' aria-required=true> <span>Visage &amp; regard<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_167cff9d6034c045f7fbddb8c5c46cbd'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Silhouette\"  id='dans_quel_domaine_se_situe_votre_demande_3_167cff9d6034c045f7fbddb8c5c46cbd' aria-label='Silhouette' aria-invalid='false' aria-required=true> <span>Silhouette<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_dabba5fcaa46fa53e773ebc30595a8f9'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Poitrine\"  id='dans_quel_domaine_se_situe_votre_demande_3_dabba5fcaa46fa53e773ebc30595a8f9' aria-label='Poitrine' aria-invalid='false' aria-required=true> <span>Poitrine<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_d403cd0a4ad744ba538dc29d3925216a'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Cheveux\"  id='dans_quel_domaine_se_situe_votre_demande_3_d403cd0a4ad744ba538dc29d3925216a' aria-label='Cheveux' aria-invalid='false' aria-required=true> <span>Cheveux<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_d85dba7ec8bfc92782f43e05de4aff32'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"M\u00e9decine &amp; soins esth\u00e9tiques\"  id='dans_quel_domaine_se_situe_votre_demande_3_d85dba7ec8bfc92782f43e05de4aff32' aria-label='M\u00e9decine &amp; soins esth\u00e9tiques' aria-invalid='false' aria-required=true> <span>M\u00e9decine &amp; soins esth\u00e9tiques<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_8fce4a9e4ef396589cfc1eedc89b3c6e'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Deuxi\u00e8me avis\"  id='dans_quel_domaine_se_situe_votre_demande_3_8fce4a9e4ef396589cfc1eedc89b3c6e' aria-label='Deuxi\u00e8me avis' aria-invalid='false' aria-required=true> <span>Deuxi\u00e8me avis<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_9a318f2395626002dc8a2e1aafce26e5'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Je ne sais pas encore\"  id='dans_quel_domaine_se_situe_votre_demande_3_9a318f2395626002dc8a2e1aafce26e5' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=true> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Plus pr\u00e9cis\u00e9ment \u2014 Visage &amp; regard\">Plus pr\u00e9cis\u00e9ment \u2014 Visage &amp; regard<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_bc6a3803dbc43c3b09be53419ab042b7'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Lifting du visage et du cou\"  id='plus_precisement_visage_regard_5_bc6a3803dbc43c3b09be53419ab042b7' aria-label='Lifting du visage et du cou' aria-invalid='false' aria-required=false> <span>Lifting du visage et du cou<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_762305887933a975d4d2f2deda3ff0e4'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Paupi\u00e8res (bl\u00e9pharoplastie)\"  id='plus_precisement_visage_regard_5_762305887933a975d4d2f2deda3ff0e4' aria-label='Paupi\u00e8res (bl\u00e9pharoplastie)' aria-invalid='false' aria-required=false> <span>Paupi\u00e8res (bl\u00e9pharoplastie)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_6342cbc02ea7f294d0bdd0a81756089f'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Rhinoplastie (nez)\"  id='plus_precisement_visage_regard_5_6342cbc02ea7f294d0bdd0a81756089f' aria-label='Rhinoplastie (nez)' aria-invalid='false' aria-required=false> <span>Rhinoplastie (nez)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_b576f70998e68c6807187a49badf2c54'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Ovale du visage &amp; bajoues\"  id='plus_precisement_visage_regard_5_b576f70998e68c6807187a49badf2c54' aria-label='Ovale du visage &amp; bajoues' aria-invalid='false' aria-required=false> <span>Ovale du visage &amp; bajoues<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_6d3834a89e691e4530cbc711576826be'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Cou &amp; double menton\"  id='plus_precisement_visage_regard_5_6d3834a89e691e4530cbc711576826be' aria-label='Cou &amp; double menton' aria-invalid='false' aria-required=false> <span>Cou &amp; double menton<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_fb90aaa99cbae76ddfbaf125ea21a251'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Oreilles d\u00e9coll\u00e9es (otoplastie)\"  id='plus_precisement_visage_regard_5_fb90aaa99cbae76ddfbaf125ea21a251' aria-label='Oreilles d\u00e9coll\u00e9es (otoplastie)' aria-invalid='false' aria-required=false> <span>Oreilles d\u00e9coll\u00e9es (otoplastie)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_0442742b727fbc19de8a826f1db5c5ca'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Harmonisation globale du visage\"  id='plus_precisement_visage_regard_5_0442742b727fbc19de8a826f1db5c5ca' aria-label='Harmonisation globale du visage' aria-invalid='false' aria-required=false> <span>Harmonisation globale du visage<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_bdaef073b4c88e32187626b768bac8bb'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Je ne sais pas encore\"  id='plus_precisement_visage_regard_5_bdaef073b4c88e32187626b768bac8bb' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=false> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Plus pr\u00e9cis\u00e9ment \u2014 Silhouette\">Plus pr\u00e9cis\u00e9ment \u2014 Silhouette<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_963193f80dcb9cefc238443f233d8d06'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Lipoaspiration cibl\u00e9e\"  id='plus_precisement_silhouette_6_963193f80dcb9cefc238443f233d8d06' aria-label='Lipoaspiration cibl\u00e9e' aria-invalid='false' aria-required=false> <span>Lipoaspiration cibl\u00e9e<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_f9415c08c08db2ff4fff545931fd31ae'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Ventre &amp; abdominoplastie\"  id='plus_precisement_silhouette_6_f9415c08c08db2ff4fff545931fd31ae' aria-label='Ventre &amp; abdominoplastie' aria-invalid='false' aria-required=false> <span>Ventre &amp; abdominoplastie<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_e99cb61fd7fa535b5033e43ba5791915'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Suites d&#039;un amaigrissement\"  id='plus_precisement_silhouette_6_e99cb61fd7fa535b5033e43ba5791915' aria-label='Suites d&#039;un amaigrissement' aria-invalid='false' aria-required=false> <span>Suites d'un amaigrissement<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_912a2d741824eb090243115322a11c69'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Cuisses &amp; hanches\"  id='plus_precisement_silhouette_6_912a2d741824eb090243115322a11c69' aria-label='Cuisses &amp; hanches' aria-invalid='false' aria-required=false> <span>Cuisses &amp; hanches<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_27b1ccf15282b3b2d87897665fbf6755'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Bras\"  id='plus_precisement_silhouette_6_27b1ccf15282b3b2d87897665fbf6755' aria-label='Bras' aria-invalid='false' aria-required=false> <span>Bras<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_58e2943226dfcf2480569ac91f41ab59'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Fessiers\"  id='plus_precisement_silhouette_6_58e2943226dfcf2480569ac91f41ab59' aria-label='Fessiers' aria-invalid='false' aria-required=false> <span>Fessiers<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_f3971d128311e660fea89f43ab4280ec'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Je ne sais pas encore\"  id='plus_precisement_silhouette_6_f3971d128311e660fea89f43ab4280ec' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=false> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Plus pr\u00e9cis\u00e9ment \u2014 Poitrine\">Plus pr\u00e9cis\u00e9ment \u2014 Poitrine<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_1787e08403063cb9f185c18563eaac6d'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Augmentation (proth\u00e8ses \/ lipofilling)\"  id='plus_precisement_poitrine_7_1787e08403063cb9f185c18563eaac6d' aria-label='Augmentation (proth\u00e8ses \/ lipofilling)' aria-invalid='false' aria-required=false> <span>Augmentation (proth\u00e8ses \/ lipofilling)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_5ea67a1c4245fd127a5c494156ef4c67'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"R\u00e9duction mammaire\"  id='plus_precisement_poitrine_7_5ea67a1c4245fd127a5c494156ef4c67' aria-label='R\u00e9duction mammaire' aria-invalid='false' aria-required=false> <span>R\u00e9duction mammaire<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_ada0001a0b50ba1877c382979aafc784'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Pt\u00f4se \/ lifting (seins rel\u00e2ch\u00e9s)\"  id='plus_precisement_poitrine_7_ada0001a0b50ba1877c382979aafc784' aria-label='Pt\u00f4se \/ lifting (seins rel\u00e2ch\u00e9s)' aria-invalid='false' aria-required=false> <span>Pt\u00f4se \/ lifting (seins rel\u00e2ch\u00e9s)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_c9e090c11d87acfa913ac3bb18f06331'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Asym\u00e9trie\"  id='plus_precisement_poitrine_7_c9e090c11d87acfa913ac3bb18f06331' aria-label='Asym\u00e9trie' aria-invalid='false' aria-required=false> <span>Asym\u00e9trie<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_a845957111b4e0f604f83cb898c9a06f'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Changement ou retrait de proth\u00e8ses\"  id='plus_precisement_poitrine_7_a845957111b4e0f604f83cb898c9a06f' aria-label='Changement ou retrait de proth\u00e8ses' aria-invalid='false' aria-required=false> <span>Changement ou retrait de proth\u00e8ses<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_49ad46d39d492c742eff57e772c27a57'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Reconstruction\"  id='plus_precisement_poitrine_7_49ad46d39d492c742eff57e772c27a57' aria-label='Reconstruction' aria-invalid='false' aria-required=false> <span>Reconstruction<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_0081f68c5eb960125143060f1cb41f88'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Gyn\u00e9comastie (homme)\"  id='plus_precisement_poitrine_7_0081f68c5eb960125143060f1cb41f88' aria-label='Gyn\u00e9comastie (homme)' aria-invalid='false' aria-required=false> <span>Gyn\u00e9comastie (homme)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_b9c904507aca537d23605c4a8c9c6bfe'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Je ne sais pas encore\"  id='plus_precisement_poitrine_7_b9c904507aca537d23605c4a8c9c6bfe' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=false> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Plus pr\u00e9cis\u00e9ment \u2014 Cheveux\">Plus pr\u00e9cis\u00e9ment \u2014 Cheveux<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_f5232f21e82894570ef84bfed9620929'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Densification \/ greffe\"  id='plus_precisement_cheveux_8_f5232f21e82894570ef84bfed9620929' aria-label='Densification \/ greffe' aria-invalid='false' aria-required=false> <span>Densification \/ greffe<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_253056b4efcc93174b3ea017cc3148ee'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Ligne frontale &amp; golfes\"  id='plus_precisement_cheveux_8_253056b4efcc93174b3ea017cc3148ee' aria-label='Ligne frontale &amp; golfes' aria-invalid='false' aria-required=false> <span>Ligne frontale &amp; golfes<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_ab324fc3701f360e0b9d3c5159bb7c07'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Vertex \/ tonsure\"  id='plus_precisement_cheveux_8_ab324fc3701f360e0b9d3c5159bb7c07' aria-label='Vertex \/ tonsure' aria-invalid='false' aria-required=false> <span>Vertex \/ tonsure<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_2d82f8bc1da3fb5910334bb1dd2ab8d4'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Sourcils &amp; barbe\"  id='plus_precisement_cheveux_8_2d82f8bc1da3fb5910334bb1dd2ab8d4' aria-label='Sourcils &amp; barbe' aria-invalid='false' aria-required=false> <span>Sourcils &amp; barbe<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_8344225a90c1bba52e0928e2ec72ce86'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Chute diffuse r\u00e9cente\"  id='plus_precisement_cheveux_8_8344225a90c1bba52e0928e2ec72ce86' aria-label='Chute diffuse r\u00e9cente' aria-invalid='false' aria-required=false> <span>Chute diffuse r\u00e9cente<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_40de3227b40c7619be7115a5c127b744'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Je ne sais pas encore\"  id='plus_precisement_cheveux_8_40de3227b40c7619be7115a5c127b744' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=false> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Plus pr\u00e9cis\u00e9ment \u2014 M\u00e9decine &amp; soins esth\u00e9tiques\">Plus pr\u00e9cis\u00e9ment \u2014 M\u00e9decine &amp; soins esth\u00e9tiques<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_b520d6cb6ca1ff258059f4791216d86f'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Injections d&#039;acide hyaluronique\"  id='plus_precisement_medecine_soins_esthetiques_9_b520d6cb6ca1ff258059f4791216d86f' aria-label='Injections d&#039;acide hyaluronique' aria-invalid='false' aria-required=false> <span>Injections d'acide hyaluronique<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_37268b232e2ba39a9cacf86d882d368d'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Rides d&#039;expression (toxine botulique)\"  id='plus_precisement_medecine_soins_esthetiques_9_37268b232e2ba39a9cacf86d882d368d' aria-label='Rides d&#039;expression (toxine botulique)' aria-invalid='false' aria-required=false> <span>Rides d'expression (toxine botulique)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_26b62da6f6a429337e1f287b3ed37fc1'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Qualit\u00e9 &amp; \u00e9clat de la peau\"  id='plus_precisement_medecine_soins_esthetiques_9_26b62da6f6a429337e1f287b3ed37fc1' aria-label='Qualit\u00e9 &amp; \u00e9clat de la peau' aria-invalid='false' aria-required=false> <span>Qualit\u00e9 &amp; \u00e9clat de la peau<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_a39118e6c251dd9058714a802e4dd4ec'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Rel\u00e2chement \/ raffermissement\"  id='plus_precisement_medecine_soins_esthetiques_9_a39118e6c251dd9058714a802e4dd4ec' aria-label='Rel\u00e2chement \/ raffermissement' aria-invalid='false' aria-required=false> <span>Rel\u00e2chement \/ raffermissement<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_9093d28d5afa3dee6852872945f1495b'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Laser (taches, rougeurs, texture)\"  id='plus_precisement_medecine_soins_esthetiques_9_9093d28d5afa3dee6852872945f1495b' aria-label='Laser (taches, rougeurs, texture)' aria-invalid='false' aria-required=false> <span>Laser (taches, rougeurs, texture)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_f3959460365ca61838f307039e0fc6d2'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Cernes &amp; regard fatigu\u00e9\"  id='plus_precisement_medecine_soins_esthetiques_9_f3959460365ca61838f307039e0fc6d2' aria-label='Cernes &amp; regard fatigu\u00e9' aria-invalid='false' aria-required=false> <span>Cernes &amp; regard fatigu\u00e9<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_61278c8e69c15f4c329110bc7094d144'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Pr\u00e9vention &amp; long\u00e9vit\u00e9\"  id='plus_precisement_medecine_soins_esthetiques_9_61278c8e69c15f4c329110bc7094d144' aria-label='Pr\u00e9vention &amp; long\u00e9vit\u00e9' aria-invalid='false' aria-required=false> <span>Pr\u00e9vention &amp; long\u00e9vit\u00e9<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_e06805587951e77bd2dcefdc682704c5'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Je ne sais pas encore\"  id='plus_precisement_medecine_soins_esthetiques_9_e06805587951e77bd2dcefdc682704c5' aria-label='Je ne sais pas encore' aria-invalid='false' aria-required=false> <span>Je ne sais pas encore<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_2\" ><p style=\"opacity:.7\">Pas de pr\u00e9cision n\u00e9cessaire \u00e0 cette \u00e9tape \u2014 continuez, nous en discuterons ensemble.<\/p><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"S&#039;agit-il d&#039;une premi\u00e8re consultation avec le Dr Desouches ?\">S'agit-il d'une premi\u00e8re consultation avec le Dr Desouches ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_0062cefac2086c845bd582c2cf3b1b47'><input  name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" value=\"Oui\"  id='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_0062cefac2086c845bd582c2cf3b1b47' aria-label='Oui' aria-invalid='false' aria-required=true> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_ad82bba3bb9d87220e218e495713e264'><input  name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" value=\"Non, je suis d\u00e9j\u00e0 venu(e)\"  id='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_ad82bba3bb9d87220e218e495713e264' aria-label='Non, je suis d\u00e9j\u00e0 venu(e)' aria-invalid='false' aria-required=true> <span>Non, je suis d\u00e9j\u00e0 venu(e)<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Avez-vous d\u00e9j\u00e0 eu une intervention ou des injections ?\">Avez-vous d\u00e9j\u00e0 eu une intervention ou des injections ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_9bde595bc5fc3d99dd6b09430b465384'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Jamais\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_9bde595bc5fc3d99dd6b09430b465384' aria-label='Jamais' aria-invalid='false' aria-required=false> <span>Jamais<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_d87f4db3bd578f2ab6792debb3357b00'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Injections\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_d87f4db3bd578f2ab6792debb3357b00' aria-label='Injections' aria-invalid='false' aria-required=false> <span>Injections<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_4d5cbd2073a0e3e97365b860a66eb854'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Chirurgie\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_4d5cbd2073a0e3e97365b860a66eb854' aria-label='Chirurgie' aria-invalid='false' aria-required=false> <span>Chirurgie<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_42aad7f622ef4c14014efae3b4873cfd'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Les deux\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_42aad7f622ef4c14014efae3b4873cfd' aria-label='Les deux' aria-invalid='false' aria-required=false> <span>Les deux<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Votre projet est-il plut\u00f4t :\">Votre projet est-il plut\u00f4t :<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_637361707235f756e2211533089f6a43'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"M\u00e9dical\"  id='votre_projet_est_il_plutot_14_637361707235f756e2211533089f6a43' aria-label='M\u00e9dical' aria-invalid='false' aria-required=false> <span>M\u00e9dical<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_4c791037b6fa7ac569825710aea09f3a'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"Chirurgical\"  id='votre_projet_est_il_plutot_14_4c791037b6fa7ac569825710aea09f3a' aria-label='Chirurgical' aria-invalid='false' aria-required=false> <span>Chirurgical<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_fa124e533b1b89bdb3e805dbd11ba3c8'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"Exploratoire\"  id='votre_projet_est_il_plutot_14_fa124e533b1b89bdb3e805dbd11ba3c8' aria-label='Exploratoire' aria-invalid='false' aria-required=false> <span>Exploratoire<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Dans quel d\u00e9lai l&#039;envisagez-vous ?\">Dans quel d\u00e9lai l'envisagez-vous ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_3086f9bca90c060b51bff41e9f3dfbc4'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Rapidement\"  id='dans_quel_delai_lenvisagez_vous_15_3086f9bca90c060b51bff41e9f3dfbc4' aria-label='Rapidement' aria-invalid='false' aria-required=false> <span>Rapidement<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_9ddb0645ed433c8825cfc7b3456bdb43'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Dans les prochaines semaines\"  id='dans_quel_delai_lenvisagez_vous_15_9ddb0645ed433c8825cfc7b3456bdb43' aria-label='Dans les prochaines semaines' aria-invalid='false' aria-required=false> <span>Dans les prochaines semaines<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_8ef840b700c5186b4444ad23d3f16f69'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Projet \u00e0 moyen terme\"  id='dans_quel_delai_lenvisagez_vous_15_8ef840b700c5186b4444ad23d3f16f69' aria-label='Projet \u00e0 moyen terme' aria-invalid='false' aria-required=false> <span>Projet \u00e0 moyen terme<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_votre_demande_17' id='label_ff_6_votre_demande_17' aria-label=\"Votre demande\">Votre demande<\/label><div class=\"ff-el-tooltip\" data-content=\"D\u00e9crivez en quelques mots ce que vous souhaitez am\u00e9liorer ou comprendre. Vous pouvez rester volontairement bref\u00b7\u00e8ve : l&apos;\u00e9change permettra de pr\u00e9ciser les choses.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_6_votre_demande_17\" name=\"votre_demande_17\" class=\"ff-el-form-control\" id=\"ff_6_votre_demande_17\" placeholder=\"Quelques lignes suffisent. Ce que vous ressentez, ce qui vous interroge, ce que vous aimeriez faire \u00e9voluer\u2026\" cols=\"2\" data-name=\"votre_demande_17\" ><\/textarea><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Souhaitez-vous recevoir des informations g\u00e9n\u00e9rales sur les honoraires avant votre rendez-vous ?\">Souhaitez-vous recevoir des informations g\u00e9n\u00e9rales sur les honoraires avant votre rendez-vous ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_173c9d27a7d3ae86ea6f8a104cbe85ea'><input  name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" value=\"Oui\"  id='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_173c9d27a7d3ae86ea6f8a104cbe85ea' aria-label='Oui' aria-invalid='false' aria-required=false> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_60656172ce7d51e1be3a94bd1b275177'><input  name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" value=\"Non\"  id='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_60656172ce7d51e1be3a94bd1b275177' aria-label='Non' aria-invalid='false' aria-required=false> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_prenom_nom_23' id='label_ff_6_prenom_nom_23' aria-label=\"Pr\u00e9nom &amp; nom\">Pr\u00e9nom &amp; nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"prenom_nom_23\" class=\"ff-el-form-control\" id=\"ff_6_prenom_nom_23\" placeholder=\"Votre nom\" data-name=\"prenom_nom_23\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_votre_ville_27' id='label_ff_6_votre_ville_27' aria-label=\"Votre ville\">Votre ville<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"votre_ville_27\" class=\"ff-el-form-control\" id=\"ff_6_votre_ville_27\" placeholder=\"Votre lieu de r\u00e9sidence\" data-name=\"votre_ville_27\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_6_email_25' id='label_ff_6_email_25' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_25\" class=\"ff-el-form-control\" id=\"ff_6_email_25\" placeholder=\"vous@exemple.com\" data-name=\"email_25\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Comment pr\u00e9f\u00e9rez-vous \u00eatre recontact\u00e9(e) ?\">Comment pr\u00e9f\u00e9rez-vous \u00eatre recontact\u00e9(e) ?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='comment_preferez_vous_etre_recontactee_22_a632166e744cb03df82e7f4700f60be1'><input  name=\"comment_preferez_vous_etre_recontactee_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"comment_preferez_vous_etre_recontactee_22\" value=\"Rappel le matin\"  id='comment_preferez_vous_etre_recontactee_22_a632166e744cb03df82e7f4700f60be1' aria-label='Rappel le matin' aria-invalid='false' aria-required=true> <span>Rappel le matin<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='comment_preferez_vous_etre_recontactee_22_763e7ab17485a0cdcc9758e6f5911d41'><input  name=\"comment_preferez_vous_etre_recontactee_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"comment_preferez_vous_etre_recontactee_22\" value=\"Rappel l&#039;apr\u00e8s-midi\"  id='comment_preferez_vous_etre_recontactee_22_763e7ab17485a0cdcc9758e6f5911d41' aria-label='Rappel l&#039;apr\u00e8s-midi' aria-invalid='false' aria-required=true> <span>Rappel l'apr\u00e8s-midi<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='comment_preferez_vous_etre_recontactee_22_e8abe3e7b45b7bb0a5108a0b3e84a84f'><input  name=\"comment_preferez_vous_etre_recontactee_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"comment_preferez_vous_etre_recontactee_22\" value=\"Premier retour par email\"  id='comment_preferez_vous_etre_recontactee_22_e8abe3e7b45b7bb0a5108a0b3e84a84f' aria-label='Premier retour par email' aria-invalid='false' aria-required=true> <span>Premier retour par email<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='comment_preferez_vous_etre_recontactee_22_3b9d1f497f987ef1dc51770c5975158b'><input  name=\"comment_preferez_vous_etre_recontactee_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"comment_preferez_vous_etre_recontactee_22\" value=\"Je suis d\u00e9j\u00e0 patient(e) du cabinet\"  id='comment_preferez_vous_etre_recontactee_22_3b9d1f497f987ef1dc51770c5975158b' aria-label='Je suis d\u00e9j\u00e0 patient(e) du cabinet' aria-invalid='false' aria-required=true> <span>Je suis d\u00e9j\u00e0 patient(e) du cabinet<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='' id='label_' aria-label=\"Consentement\">Consentement<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='consentement_26_c5231dd117336ac348d7d9f9dcf46748'><input  name=\"consentement_26[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"consentement_26\" value=\"1\" 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                   <span class=\"et-pb-icon dipi-home-icon\"><\/span>                                    Accoglienza                                <\/span>\n                            <\/a>\n\n                                                <meta itemprop=\"position\" content=\"1\"\/>                    <\/li>\n\n                    <li class=\"dipi-breadcrumb-separator\">\n                    <span class=\"et-pb-icon dipi-separator-icon\">$<\/span>\n                <\/li>                            \n                <\/ul>\n            <\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div><div class='fluentform ff-default fluentform_wrapper_6 ffs_default_wrap'><form data-form_id=\"6\" id=\"fluentform_6\" class=\"frm-fluent-form fluent_form_6 ff-el-form-top ff_form_instance_6_2 ff-form-loading ff_has_v3_recptcha ff_has_v3_recptcha ffs_default\" data-form_instance=\"ff_form_instance_6_2\" method=\"POST\" data-recptcha_key=\"6LdAwnUaAAAAAKZfV0oVIKbWB_9yZADKB4SubQic\" action=\"\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Richiesta di consultazione privata<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='23421005' \/><input type=\"hidden\" id=\"_fluentform_6_fluentformnonce\" name=\"_fluentform_6_fluentformnonce\" value=\"8e05513b55\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/it\/wp-json\/wp\/v2\/pages\/23421005\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_1\" ><div class=\"dcd-intro\"><h2>Richiesta di consultazione privata<\/h2><p>Per offrirti un servizio personalizzato, il nostro studio ti invita a compilare questo breve questionario. Dopo aver esaminato la tua richiesta, il nostro team ti contatter\u00e0 per fissare un appuntamento nel momento pi\u00f9 opportuno.<\/p><ul><li><strong>Pochi minuti<\/strong> \u00c8 sufficiente cos\u00ec: puoi procedere al tuo ritmo.<\/li><li><strong>Riservato.<\/strong> Le tue informazioni vengono esaminate dal team dell&#039;azienda e non vengono mai divulgate.<\/li><li><strong>Nessun obbligo.<\/strong> Questo questionario vi prepara al colloquio; non sostituisce una visita medica.<\/li><\/ul><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"In quale ambito rientra la tua richiesta?\">In quale ambito rientra la tua richiesta?<\/label><div class=\"ff-el-tooltip\" data-content=\"Votre projet\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_549ca3c8ff86f126495b4a06baf4bc50'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Visage &amp; regard\"  id='dans_quel_domaine_se_situe_votre_demande_3_549ca3c8ff86f126495b4a06baf4bc50' aria-label='Viso e occhi' aria-invalid='false' aria-required=\"true\"> <span>Viso e occhi<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_fa46f3f9bb47e107b37e48b569267629'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Silhouette\"  id='dans_quel_domaine_se_situe_votre_demande_3_fa46f3f9bb47e107b37e48b569267629' aria-label='Silhouette' aria-invalid='false' aria-required=\"true\"> <span>Silhouette<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_158e1658527ec51ed647f31aa4a8defc'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Poitrine\"  id='dans_quel_domaine_se_situe_votre_demande_3_158e1658527ec51ed647f31aa4a8defc' aria-label='Petto' aria-invalid='false' aria-required=\"true\"> <span>Petto<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_4a5cfa9bcee3dab92eb0a2c12136dd64'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Cheveux\"  id='dans_quel_domaine_se_situe_votre_demande_3_4a5cfa9bcee3dab92eb0a2c12136dd64' aria-label='Capelli' aria-invalid='false' aria-required=\"true\"> <span>Capelli<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_319b7d809662bdf5c509da1716068682'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"M\u00e9decine &amp; soins esth\u00e9tiques\"  id='dans_quel_domaine_se_situe_votre_demande_3_319b7d809662bdf5c509da1716068682' aria-label='Medicina e trattamenti estetici' aria-invalid='false' aria-required=\"true\"> <span>Medicina e trattamenti estetici<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_1502863dc27a63ae670961ba2350cbb8'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Deuxi\u00e8me avis\"  id='dans_quel_domaine_se_situe_votre_demande_3_1502863dc27a63ae670961ba2350cbb8' aria-label='Seconda opinione' aria-invalid='false' aria-required=\"true\"> <span>Seconda opinione<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_domaine_se_situe_votre_demande_3_dc58d67695a42b34d28fad6382bf268d'><input  name=\"dans_quel_domaine_se_situe_votre_demande_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_domaine_se_situe_votre_demande_3\" value=\"Je ne sais pas encore\"  id='dans_quel_domaine_se_situe_votre_demande_3_dc58d67695a42b34d28fad6382bf268d' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"true\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Pi\u00f9 nello specifico: viso e occhi\">Pi\u00f9 nello specifico: viso e occhi<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_fe6af41f7088b7462b28ab11185d6910'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Lifting du visage et du cou\"  id='plus_precisement_visage_regard_5_fe6af41f7088b7462b28ab11185d6910' aria-label='Lifting del viso e del collo' aria-invalid='false' aria-required=\"false\"> <span>Lifting del viso e del collo<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_70cddde46c19ba5d43d8892f782f3851'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Paupi\u00e8res (bl\u00e9pharoplastie)\"  id='plus_precisement_visage_regard_5_70cddde46c19ba5d43d8892f782f3851' aria-label='Palpebre (blefaroplastica)' aria-invalid='false' aria-required=\"false\"> <span>Palpebre (blefaroplastica)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_ecf5ef2df50637b081fa27bcee83bf09'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Rhinoplastie (nez)\"  id='plus_precisement_visage_regard_5_ecf5ef2df50637b081fa27bcee83bf09' aria-label='Rinoplastica (naso)' aria-invalid='false' aria-required=\"false\"> <span>Rinoplastica (naso)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_43300eb5065ee5fba212f8ed02e1b8bb'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Ovale du visage &amp; bajoues\"  id='plus_precisement_visage_regard_5_43300eb5065ee5fba212f8ed02e1b8bb' aria-label='Viso ovale e guance cadenti' aria-invalid='false' aria-required=\"false\"> <span>Viso ovale e guance cadenti<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_5d3632204abea7088c6cde6df3449c4f'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Cou &amp; double menton\"  id='plus_precisement_visage_regard_5_5d3632204abea7088c6cde6df3449c4f' aria-label='Collo e doppio mento' aria-invalid='false' aria-required=\"false\"> <span>Collo e doppio mento<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_82df384f982d0b1892440db7291c8471'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Oreilles d\u00e9coll\u00e9es (otoplastie)\"  id='plus_precisement_visage_regard_5_82df384f982d0b1892440db7291c8471' aria-label='Orecchie sporgenti (otoplastica)' aria-invalid='false' aria-required=\"false\"> <span>Orecchie sporgenti (otoplastica)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_2c0e185e7f6101d3d5d193151dec5cc3'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Harmonisation globale du visage\"  id='plus_precisement_visage_regard_5_2c0e185e7f6101d3d5d193151dec5cc3' aria-label='Armonizzazione complessiva del viso' aria-invalid='false' aria-required=\"false\"> <span>Armonizzazione complessiva del viso<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_visage_regard_5_35a00cfc0c90e1fd801a7ccb07a18156'><input  name=\"plus_precisement_visage_regard_5[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_visage_regard_5\" value=\"Je ne sais pas encore\"  id='plus_precisement_visage_regard_5_35a00cfc0c90e1fd801a7ccb07a18156' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"false\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Pi\u00f9 nello specifico, la silhouette\">Pi\u00f9 nello specifico, la silhouette<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_3c64ac135e799cef89a5439a23fce292'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Lipoaspiration cibl\u00e9e\"  id='plus_precisement_silhouette_6_3c64ac135e799cef89a5439a23fce292' aria-label='liposuzione mirata' aria-invalid='false' aria-required=\"false\"> <span>liposuzione mirata<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_cc5ffc8190bc150260702c8e71b4b861'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Ventre &amp; abdominoplastie\"  id='plus_precisement_silhouette_6_cc5ffc8190bc150260702c8e71b4b861' aria-label='Addome e addominoplastica' aria-invalid='false' aria-required=\"false\"> <span>Addome e addominoplastica<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_dbee688bdc3b11992011c34daedab955'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Suites d&#039;un amaigrissement\"  id='plus_precisement_silhouette_6_dbee688bdc3b11992011c34daedab955' aria-label='Conseguenze della perdita di peso' aria-invalid='false' aria-required=\"false\"> <span>Conseguenze della perdita di peso<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_ba2b0d7ffc21be1fea2b9c8aace65323'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Cuisses &amp; hanches\"  id='plus_precisement_silhouette_6_ba2b0d7ffc21be1fea2b9c8aace65323' aria-label='Cosce e fianchi' aria-invalid='false' aria-required=\"false\"> <span>Cosce e fianchi<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_17cef196eebaa0b7f1c5d80b9881440c'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Bras\"  id='plus_precisement_silhouette_6_17cef196eebaa0b7f1c5d80b9881440c' aria-label='Braccio' aria-invalid='false' aria-required=\"false\"> <span>Braccio<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_4fbd610f260aeee6a097b43ecfc352e5'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Fessiers\"  id='plus_precisement_silhouette_6_4fbd610f260aeee6a097b43ecfc352e5' aria-label='Glutei' aria-invalid='false' aria-required=\"false\"> <span>Glutei<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_silhouette_6_b34a24c114179d644213b40799a9838d'><input  name=\"plus_precisement_silhouette_6[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_silhouette_6\" value=\"Je ne sais pas encore\"  id='plus_precisement_silhouette_6_b34a24c114179d644213b40799a9838d' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"false\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Pi\u00f9 nello specifico: torace\">Pi\u00f9 nello specifico: torace<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_a2df80bf7ec9b6f5931a17a758682bf2'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Augmentation (proth\u00e8ses \/ lipofilling)\"  id='plus_precisement_poitrine_7_a2df80bf7ec9b6f5931a17a758682bf2' aria-label='Aumento del seno (protesi \/ lipofilling)' aria-invalid='false' aria-required=\"false\"> <span>Aumento del seno (protesi \/ lipofilling)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_3eb6f968785d568d3b7445fd72fcaa58'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"R\u00e9duction mammaire\"  id='plus_precisement_poitrine_7_3eb6f968785d568d3b7445fd72fcaa58' aria-label='Riduzione del seno' aria-invalid='false' aria-required=\"false\"> <span>Riduzione del seno<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_7ea0f83c02754f76e214c72c4f83f796'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Pt\u00f4se \/ lifting (seins rel\u00e2ch\u00e9s)\"  id='plus_precisement_poitrine_7_7ea0f83c02754f76e214c72c4f83f796' aria-label='Ptosi\/sollevamento (seno cadente)' aria-invalid='false' aria-required=\"false\"> <span>Ptosi\/sollevamento (seno cadente)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_5a7ecff8ddd749330c8fc6e03ee18411'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Asym\u00e9trie\"  id='plus_precisement_poitrine_7_5a7ecff8ddd749330c8fc6e03ee18411' aria-label='Asimmetria' aria-invalid='false' aria-required=\"false\"> <span>Asimmetria<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_536ad89f3f63797b9cc044e7b17b4986'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Changement ou retrait de proth\u00e8ses\"  id='plus_precisement_poitrine_7_536ad89f3f63797b9cc044e7b17b4986' aria-label='Sostituzione o rimozione di protesi' aria-invalid='false' aria-required=\"false\"> <span>Sostituzione o rimozione di protesi<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_2bc90acbc81ad5e280c8337894bef3b1'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Reconstruction\"  id='plus_precisement_poitrine_7_2bc90acbc81ad5e280c8337894bef3b1' aria-label='Ricostruzione' aria-invalid='false' aria-required=\"false\"> <span>Ricostruzione<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_c56138002dc9fe58a877ced7a9b91997'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Gyn\u00e9comastie (homme)\"  id='plus_precisement_poitrine_7_c56138002dc9fe58a877ced7a9b91997' aria-label='Ginecomastia (maschile)' aria-invalid='false' aria-required=\"false\"> <span>Ginecomastia (maschile)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_poitrine_7_86637d786a7e498a06bde3a62acd6f27'><input  name=\"plus_precisement_poitrine_7[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_poitrine_7\" value=\"Je ne sais pas encore\"  id='plus_precisement_poitrine_7_86637d786a7e498a06bde3a62acd6f27' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"false\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Pi\u00f9 nello specifico \u2014 Capelli\">Pi\u00f9 nello specifico \u2014 Capelli<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_27f51935095075c4cd4e86b0d4b96b4a'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Densification \/ greffe\"  id='plus_precisement_cheveux_8_27f51935095075c4cd4e86b0d4b96b4a' aria-label='Densificazione \/ Innesto' aria-invalid='false' aria-required=\"false\"> <span>Densificazione \/ Innesto<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_e8135dda1f8a97b2e18b6d2240736e10'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Ligne frontale &amp; golfes\"  id='plus_precisement_cheveux_8_e8135dda1f8a97b2e18b6d2240736e10' aria-label='Attaccatura dei capelli e tempie' aria-invalid='false' aria-required=\"false\"> <span>Attaccatura dei capelli e tempie<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_c91424c6f1399d56621407bf02ceedec'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Vertex \/ tonsure\"  id='plus_precisement_cheveux_8_c91424c6f1399d56621407bf02ceedec' aria-label='Vertice \/ tonsura' aria-invalid='false' aria-required=\"false\"> <span>Vertice \/ tonsura<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_564e6cb7853c49c0fc4547291ff54daa'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Sourcils &amp; barbe\"  id='plus_precisement_cheveux_8_564e6cb7853c49c0fc4547291ff54daa' aria-label='Sopracciglia e barba' aria-invalid='false' aria-required=\"false\"> <span>Sopracciglia e barba<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_cd83bdcb97facd2757459f2b3fb40984'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Chute diffuse r\u00e9cente\"  id='plus_precisement_cheveux_8_cd83bdcb97facd2757459f2b3fb40984' aria-label='Declino diffuso recente' aria-invalid='false' aria-required=\"false\"> <span>Declino diffuso recente<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_cheveux_8_aacdd1d2a3a46ec669ea506ddc50c674'><input  name=\"plus_precisement_cheveux_8[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_cheveux_8\" value=\"Je ne sais pas encore\"  id='plus_precisement_cheveux_8_aacdd1d2a3a46ec669ea506ddc50c674' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"false\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='' id='label_' aria-label=\"Pi\u00f9 nello specifico: Medicina e trattamenti estetici\">Pi\u00f9 nello specifico: Medicina e trattamenti estetici<\/label><div class=\"ff-el-tooltip\" data-content=\"Ce qui s&apos;en rapproche le plus \u2014 plusieurs r\u00e9ponses possibles.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_80a8281bb575c7c99d0a438de071a5aa'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Injections d&#039;acide hyaluronique\"  id='plus_precisement_medecine_soins_esthetiques_9_80a8281bb575c7c99d0a438de071a5aa' aria-label='iniezioni di acido ialuronico' aria-invalid='false' aria-required=\"false\"> <span>iniezioni di acido ialuronico<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_bda62673b8064efa7f8fcc5fd404f1e4'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Rides d&#039;expression (toxine botulique)\"  id='plus_precisement_medecine_soins_esthetiques_9_bda62673b8064efa7f8fcc5fd404f1e4' aria-label='Linee di espressione (tossina botulinica)' aria-invalid='false' aria-required=\"false\"> <span>Linee di espressione (tossina botulinica)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_0fd2d925d48b256cf9106938eb2541de'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Qualit\u00e9 &amp; \u00e9clat de la peau\"  id='plus_precisement_medecine_soins_esthetiques_9_0fd2d925d48b256cf9106938eb2541de' aria-label='Qualit\u00e0 e luminosit\u00e0 della pelle' aria-invalid='false' aria-required=\"false\"> <span>Qualit\u00e0 e luminosit\u00e0 della pelle<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_2fa9230c3475a4667f0e95f9196c544b'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Rel\u00e2chement \/ raffermissement\"  id='plus_precisement_medecine_soins_esthetiques_9_2fa9230c3475a4667f0e95f9196c544b' aria-label='Rilassamento\/rassodamento' aria-invalid='false' aria-required=\"false\"> <span>Rilassamento\/rassodamento<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_792b99f57ec8cdab6a04ffa62fcf3a7a'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Laser (taches, rougeurs, texture)\"  id='plus_precisement_medecine_soins_esthetiques_9_792b99f57ec8cdab6a04ffa62fcf3a7a' aria-label='Laser (macchie, rossore, consistenza)' aria-invalid='false' aria-required=\"false\"> <span>Laser (macchie, rossore, consistenza)<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_8420ba3414deb0ecb7a1a9e68e3fbdfa'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Cernes &amp; regard fatigu\u00e9\"  id='plus_precisement_medecine_soins_esthetiques_9_8420ba3414deb0ecb7a1a9e68e3fbdfa' aria-label='Occhiaie e occhi stanchi' aria-invalid='false' aria-required=\"false\"> <span>Occhiaie e occhi stanchi<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_6fc239553ac0a1d6c11e2b53da5bdfe8'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Pr\u00e9vention &amp; long\u00e9vit\u00e9\"  id='plus_precisement_medecine_soins_esthetiques_9_6fc239553ac0a1d6c11e2b53da5bdfe8' aria-label='Prevenzione e longevit\u00e0' aria-invalid='false' aria-required=\"false\"> <span>Prevenzione e longevit\u00e0<\/span><\/label><\/div><div class='ff-el-form-check'><label class='ff-el-form-check-label' for='plus_precisement_medecine_soins_esthetiques_9_162cf14b25035bbf112378ad2dd613b4'><input  name=\"plus_precisement_medecine_soins_esthetiques_9[]\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" type=\"checkbox\" data-name=\"plus_precisement_medecine_soins_esthetiques_9\" value=\"Je ne sais pas encore\"  id='plus_precisement_medecine_soins_esthetiques_9_162cf14b25035bbf112378ad2dd613b4' aria-label='Non lo so ancora.' aria-invalid='false' aria-required=\"false\"> <span>Non lo so ancora.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-6_2\" ><p style=\"opacity:.7\">Al momento non servono ulteriori dettagli: avanti, ne parleremo insieme.<\/p><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"\u00c8 la sua prima visita con il Dottor Desouches?\">\u00c8 la sua prima visita con il Dottor Desouches?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_a9b9da257b596b98641d9e92ec1edb83'><input  name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" value=\"Oui\"  id='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_a9b9da257b596b98641d9e92ec1edb83' aria-label='S\u00cc' aria-invalid='false' aria-required=\"true\"> <span>S\u00cc<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_1a88c40ec05d49323cafbb2e7b6d0db6'><input  name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12\" value=\"Non, je suis d\u00e9j\u00e0 venu(e)\"  id='sagit_il_dune_premiere_consultation_avec_le_dr_desouches_12_1a88c40ec05d49323cafbb2e7b6d0db6' aria-label='No, sono gi\u00e0 stato qui.' aria-invalid='false' aria-required=\"true\"> <span>No, sono gi\u00e0 stato qui.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Hai mai subito un intervento chirurgico o delle iniezioni?\">Hai mai subito un intervento chirurgico o delle iniezioni?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_116b34ce1dc1d8c0c77ea15e00387495'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Jamais\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_116b34ce1dc1d8c0c77ea15e00387495' aria-label='Mai' aria-invalid='false' aria-required=\"false\"> <span>Mai<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_0dd1f813d407b117afa66aa3fad9fbe9'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Injections\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_0dd1f813d407b117afa66aa3fad9fbe9' aria-label='Iniezioni' aria-invalid='false' aria-required=\"false\"> <span>Iniezioni<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_47dc867f321a6473c7571200e07bfeb4'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Chirurgie\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_47dc867f321a6473c7571200e07bfeb4' aria-label='Chirurgia' aria-invalid='false' aria-required=\"false\"> <span>Chirurgia<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='avez_vous_deja_eu_une_intervention_ou_des_injections_13_e9d4722f3214864ecedf4a1e99ea5cf8'><input  name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"avez_vous_deja_eu_une_intervention_ou_des_injections_13\" value=\"Les deux\"  id='avez_vous_deja_eu_une_intervention_ou_des_injections_13_e9d4722f3214864ecedf4a1e99ea5cf8' aria-label='Entrambi' aria-invalid='false' aria-required=\"false\"> <span>Entrambi<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Il tuo progetto assomiglia di pi\u00f9 a:\">Il tuo progetto assomiglia di pi\u00f9 a:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_b5af1f759f279b9faeb329f9872192d1'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"M\u00e9dical\"  id='votre_projet_est_il_plutot_14_b5af1f759f279b9faeb329f9872192d1' aria-label='Medico' aria-invalid='false' aria-required=\"false\"> <span>Medico<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_691f5f78809507723870941af7df0365'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"Chirurgical\"  id='votre_projet_est_il_plutot_14_691f5f78809507723870941af7df0365' aria-label='Chirurgico' aria-invalid='false' aria-required=\"false\"> <span>Chirurgico<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='votre_projet_est_il_plutot_14_cab0f2de7f0b6555b484433fc9840be8'><input  name=\"votre_projet_est_il_plutot_14\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"votre_projet_est_il_plutot_14\" value=\"Exploratoire\"  id='votre_projet_est_il_plutot_14_cab0f2de7f0b6555b484433fc9840be8' aria-label='Esplorativo' aria-invalid='false' aria-required=\"false\"> <span>Esplorativo<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Quali sono le tempistiche previste?\">Quali sono le tempistiche previste?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_b19aeb8b7955d909e8715c211bb9feea'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Rapidement\"  id='dans_quel_delai_lenvisagez_vous_15_b19aeb8b7955d909e8715c211bb9feea' aria-label='Velocemente' aria-invalid='false' aria-required=\"false\"> <span>Velocemente<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_a7736921d87a4fcc53ae147b5d10b5e6'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Dans les prochaines semaines\"  id='dans_quel_delai_lenvisagez_vous_15_a7736921d87a4fcc53ae147b5d10b5e6' aria-label='Nelle prossime settimane' aria-invalid='false' aria-required=\"false\"> <span>Nelle prossime settimane<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='dans_quel_delai_lenvisagez_vous_15_2eabcd0c811a40bdd16c04a2a05e97e3'><input  name=\"dans_quel_delai_lenvisagez_vous_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"dans_quel_delai_lenvisagez_vous_15\" value=\"Projet \u00e0 moyen terme\"  id='dans_quel_delai_lenvisagez_vous_15_2eabcd0c811a40bdd16c04a2a05e97e3' aria-label='Progetto a medio termine' aria-invalid='false' aria-required=\"false\"> <span>Progetto a medio termine<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_6_2_votre_demande_17' id='label_ff_6_2_votre_demande_17' aria-label=\"La tua richiesta\">La tua richiesta<\/label><div class=\"ff-el-tooltip\" data-content=\"D\u00e9crivez en quelques mots ce que vous souhaitez am\u00e9liorer ou comprendre. Vous pouvez rester volontairement bref\u00b7\u00e8ve : l&apos;\u00e9change permettra de pr\u00e9ciser les choses.\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_6_2_votre_demande_17\" name=\"votre_demande_17\" class=\"ff-el-form-control\" id=\"ff_6_2_votre_demande_17\" placeholder=\"Bastano poche righe. Cosa provi, quali domande ti poni, cosa vorresti cambiare\u2026\" cols=\"2\" data-name=\"votre_demande_17\" ><\/textarea><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Desidera ricevere informazioni generali sulle tariffe prima dell&#039;appuntamento?\">Desidera ricevere informazioni generali sulle tariffe prima dell&#039;appuntamento?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_d6aaaad1beb4d16f8fd5ab7ea66317cf'><input  name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" value=\"Oui\"  id='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_d6aaaad1beb4d16f8fd5ab7ea66317cf' aria-label='S\u00cc' aria-invalid='false' aria-required=\"false\"> <span>S\u00cc<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_71439bdb62663696382eca54fe3b81e4'><input  name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" type=\"radio\" data-name=\"souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21\" value=\"Non\"  id='souhaitez_vous_recevoir_des_informations_generales_sur_les_honoraires_avant_votre_rendez_vous_21_71439bdb62663696382eca54fe3b81e4' aria-label='NO' aria-invalid='false' aria-required=\"false\"> 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