{"id":22456,"date":"2025-10-27T09:02:54","date_gmt":"2025-10-27T09:02:54","guid":{"rendered":"https:\/\/www.centre-ortho.ch\/?page_id=22456"},"modified":"2025-11-04T10:05:47","modified_gmt":"2025-11-04T10:05:47","slug":"mobility-assessment-form-page-1","status":"publish","type":"page","link":"https:\/\/www.centre-ortho.ch\/en\/mobility-assessment-form-page-1\/","title":{"rendered":"Mobility Assessment Form \u2013 Page 1"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"22456\" class=\"elementor elementor-22456\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-907b43d e-flex e-con-boxed e-con e-parent\" data-id=\"907b43d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-32118c0 widget-coo e-flex e-con-boxed e-con e-parent\" data-id=\"32118c0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-213b985 elementor-widget elementor-widget-heading\" data-id=\"213b985\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Mobility assessment<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f924284 e-flex e-con-boxed e-con e-parent\" data-id=\"f924284\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-5f63b2c5 e-con-full e-flex e-con e-child\" data-id=\"5f63b2c5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-505688f1 e-con-full e-flex e-con e-child\" data-id=\"505688f1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-490b1dd e-con-full e-flex e-con e-child\" data-id=\"490b1dd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-776c374e elementor-widget elementor-widget-heading\" data-id=\"776c374e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pre-consultation questionnaire 1\/3<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-715c1b4 elementor-widget elementor-widget-text-editor\" data-id=\"715c1b4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Important: Please complete this questionnaire as accurately as possible. This information will allow us to better assist you during your consultation.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5df4e4f e-flex e-con-boxed e-con e-parent\" data-id=\"5df4e4f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c177e67 elementor-widget__width-inherit elementor-widget-mobile__width-inherit elementor-widget elementor-widget-shortcode\" data-id=\"c177e67\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f16120-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"16120\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/22456#wpcf7-f16120-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/22456#wpcf7-f16120-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"16120\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f16120-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:16120,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;,&quot;notice_dismissed_rollback-cf7-6.1.1&quot;:true}}\" \/>\n<\/fieldset>\n<div class='row'>\n  <div>\n\n    <div class='wgl_col-12'>\n      <h3 style=\"font-size: 22px; line-height: 1em; padding-bottom: 20px;\">General Information<\/h3>\n    <\/div>\n\n    <div class='wgl_col-6'>\n      <label>Name *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"family-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"your-nom\" \/><\/span>\n    <\/div>\n\n    <div class='wgl_col-6'>\n      <label>First name *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"given-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"your-prenom\" \/><\/span>\n    <\/div>\n\n    <div class='wgl_col-6'>\n      <label>Phone *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"tel\" name=\"your-tel\" \/><\/span>\n    <\/div>\n\n    <div class='wgl_col-6'>\n      <label>E-mail<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n    <\/div>\n\n    <div class=\"wgl_col-6\">\n      <label>Sex *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-sex\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required horizontal\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"your-sex[]\" value=\"Homme\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"your-sex[]\" value=\"Femme\" \/><span class=\"wpcf7-list-item-label\">Women<\/span><\/span><\/span><\/span>\n    <\/div>\n\n    <div class='wgl_col-6'>\n      <label>Date of birth *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-date-naissance\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"your-date-naissance\" \/><\/span>\n    <\/div>\n\n    <div class='wgl_col-12'>\n      <h3 style=\"font-size: 22px; line-height: 1em;\">Reason for consultation<\/h3>\n    <\/div>\n\n    <div class='wgl_col-12'>\n      <label>Describe your main complaint *<\/label>\n      <span class=\"wpcf7-form-control-wrap\" data-name=\"your-plainte\"><textarea cols=\"40\" rows=\"10\" maxlength=\"500\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Example: Knee pain, difficulty walking...\" name=\"your-plainte\"><\/textarea><\/span>\n    <\/div>\n\n  <\/div>\n\n  <div>\n    <br><br>\n  <\/div>\n\n  <input type=\"hidden\" name=\"_cf7msm_multistep_tag\" class=\"wpcf7-form-control wpcf7-multistep cf7msm-multistep\" value=\"{&quot;first_step&quot;:1,&quot;next_url&quot;:&quot;\\\/formulaire-bilan-mobilite-page-2\\\/&quot;}\" \/><input type=\"hidden\" name=\"cf7msm-no-ss\" value=\"\" \/>\n\n  <div class='wgl_col-6' style=\"padding-top: 20px;\">\n    <input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Following\" \/>\n  <\/div>\n<\/div><input type=\"text\" class=\"wpcf7_hp_field\" name=\"wpcf7_hp_field\" value=\"\" tabindex=\"-1\" autocomplete=\"off\" \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Bilan de mobilit\u00e9 Questionnaire pr\u00e9consultation 1\/3 Important : Remplissez ce questionnaire le plus pr\u00e9cis\u00e9ment possible. Ces informations nous permettront de mieux vous prendre en charge lors de votre consultation.<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-22456","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/pages\/22456","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/comments?post=22456"}],"version-history":[{"count":0,"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/pages\/22456\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.centre-ortho.ch\/en\/wp-json\/wp\/v2\/media?parent=22456"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}