{"id":782,"date":"2015-10-15T15:26:20","date_gmt":"2015-10-15T15:26:20","guid":{"rendered":"http:\/\/chuv.umontreal.ca\/english\/?page_id=782"},"modified":"2019-09-24T11:25:37","modified_gmt":"2019-09-24T15:25:37","slug":"complaint-form","status":"publish","type":"page","link":"https:\/\/chuv.umontreal.ca\/english\/about-the-chuv\/complaint-form\/","title":{"rendered":"Complaint form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]<\/p>\n<h1><strong>Complaint form<\/strong><\/h1>\n<p>[\/vc_column_text][vc_empty_space height=&#8221;32px&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f788-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"788\">\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\/782#wpcf7-f788-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=\"788\" \/><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-f788-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>Your name (obligatoire)\n<\/p>\n<p><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>\n<\/p>\n<p>Email address (obligatoire)\n<\/p>\n<p><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>\n<\/p>\n<p>Phone number\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"phonenumber\"><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=\"phonenumber\" \/><\/span>\n<\/p>\n<p>Patient file number\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"numdossier\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"numdossier\" \/><\/span>\n<\/p>\n<p>Animal name*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nomanimal\"><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=\"nomanimal\" \/><\/span>\n<\/p>\n<p>Race or species*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"race\"><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=\"race\" \/><\/span>\n<\/p>\n<p>Date of the event\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date\" \/><\/span>\n<\/p>\n<p>Facts*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"expose\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"expose\"><\/textarea><\/span>\n<\/p>\n<p>Expected results\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"resultats\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"resultats\"><\/textarea><\/span>\n<\/p>\n<p>To better treat my complaint, I authorize the customer service department to release a copy of this document to the appropriate superintendents of the CHUV. Confidentiality will be maintained throughout the process.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Confidentialite\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"Confidentialite[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Please note that submitting a complaint does not exonerate you from any outstanding invoices.\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_text] Complaint form [\/vc_column_text][vc_empty_space height=&#8221;32px&#8221;][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":751,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-782","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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