{"id":2260,"date":"2018-04-09T13:38:32","date_gmt":"2018-04-09T13:38:32","guid":{"rendered":"http:\/\/chuv.umontreal.ca\/english\/?page_id=2260"},"modified":"2019-09-24T11:25:47","modified_gmt":"2019-09-24T15:25:47","slug":"medical-file-copy-request","status":"publish","type":"page","link":"https:\/\/chuv.umontreal.ca\/english\/about-the-chuv\/customer-service\/medical-file-copy-request\/","title":{"rendered":"Medical file copy request"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2259-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"2259\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/english\/wp-json\/wp\/v2\/pages\/2260#wpcf7-f2259-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2259\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2259-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label> I hereby authorise the Centre Hospitalier Universitaire V\u00e9t\u00e9rinaire to copy the following file:<br \/>\nFile number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"numero\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"numero\" \/><\/span> <\/label>\n<\/p>\n<p><label> Name of the animal (obligatory)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"animal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"animal\" \/><\/span> <\/label>\n<\/p>\n<p><label> Owner name (obligatory)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Email adress (obligatory)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone number (obligatory)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telephone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Reason for obtaining copy: (obligatory)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"raison\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"raison\" \/><\/span> <\/label>\n<\/p>\n<p>Please note that you will be charged for the copy of your pet's medical file. We will contact you to inform you of these upon receipt of this form in order to obtain your authorization before proceeding.\n<\/p>\n<p><label>The price is subject to change if the file is very large. In this case, you will be contacted directly to be notified.<\/label>\n<\/p>\n<p><label>Sending the copy by<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Envoi\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Envoi\"><option value=\"Mail\">Mail<\/option><option value=\"Fax\">Fax<\/option><\/select><\/span>\n<\/p>\n<p><label> Address or fax number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"coordonnees\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"coordonnees\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> We will contact you soon for the payment and confirm your request.<br \/>\n<\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":781,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2260","page","type-page","status-publish","hentry","description-off"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - 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