


{"id":364,"date":"2023-10-30T12:20:07","date_gmt":"2023-10-30T12:20:07","guid":{"rendered":"https:\/\/summitss.ca\/embaucher-un-soignant\/"},"modified":"2024-04-17T17:54:19","modified_gmt":"2024-04-17T17:54:19","slug":"embaucher-un-soignant","status":"publish","type":"page","link":"https:\/\/summitss.ca\/fr\/embaucher-un-soignant\/","title":{"rendered":"Embaucher un soignant"},"content":{"rendered":"<p><div class=\"fusion-bg-parallax\" data-bg-align=\"center center\" data-direction=\"up\" data-mute=\"false\" data-opacity=\"100\" data-velocity=\"-0.4\" data-mobile-enabled=\"false\" data-break_parents=\"0\" data-bg-image=\"https:\/\/summitss.ca\/wp-content\/uploads\/2023\/10\/header-image-contact.jpg\" data-bg-repeat=\"false\" ><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container fusion-parallax-up nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:10%;--awb-padding-right:5%;--awb-padding-bottom:10%;--awb-padding-left:5%;--awb-background-image:url(&quot;https:\/\/summitss.ca\/wp-content\/uploads\/2023\/10\/header-image-contact.jpg&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:calc( 1200px + 0px );margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0px;--awb-margin-bottom-large:20px;--awb-spacing-left-large:0px;--awb-width-medium:100%;--awb-spacing-right-medium:0px;--awb-spacing-left-medium:0px;--awb-width-small:100%;--awb-spacing-right-small:0px;--awb-spacing-left-small:0px;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:var(--awb-color1);--awb-margin-top:50px;--awb-margin-bottom:30px;\"><h1 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\"><span style=\"color: var(--awb-color5);\">Embaucher un soignant <\/span><\/h1><\/div><div class=\"fusion-text fusion-text-1\"><p style=\"font-size: 26px; line-height: 36px; text-align: center;\"><span style=\"color: var(--awb-color1);\">Nous sommes disponibles 7 jours sur 7 et avons des horaires de bureau sp\u00e9cifiques avec tous les soignants membres du personnel. En dehors des heures normales de bureau, vous pouvez recevoir un o<\/span><span style=\"color: var(--awb-color1); font-family: var(--awb-text-font-family); font-style: var(--awb-text-font-style); font-weight: var(--awb-text-font-weight); letter-spacing: var(--awb-letter-spacing); text-transform: var(--awb-text-transform); background-color: var(--awb-bg-color-hover);\">n appelez un prestataire de soins \u00e0 domicile chez vous si n\u00e9cessaire.<\/span><\/p>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:40px;width:100%;\"><\/div><a class=\"fb-icon-element-1 fb-icon-element fontawesome-icon awb-health-chevron-down circle-no fusion-animated fusion-link fusion-one-page-text-link\" style=\"--awb-font-size:70px;--awb-margin-top:0;--awb-margin-right:0;--awb-margin-bottom:0;--awb-margin-left:0;--awb-align-self:center;\" data-animationType=\"fadeInUp\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\" href=\"#contact\" aria-label=\"Link to #contact\" target=\"_self\"><\/a><\/div><\/div><\/div><\/div><div id=\"contact\" class=\"fusion-container-anchor\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-position:left top;--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:0px;--awb-padding-right:0px;--awb-padding-bottom:0px;--awb-padding-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_3_5 3_5 fusion-flex-column\" style=\"--awb-padding-top:100px;--awb-padding-right:10%;--awb-padding-bottom:100px;--awb-padding-left:10%;--awb-bg-blend:overlay;--awb-bg-size:cover;--awb-width-large:60%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.2%;--awb-width-medium:60%;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.2%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-two\"><h2 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\"><strong>Rendez-vous le jour m\u00eame<\/strong><\/h2><\/div><div class=\"fusion-text fusion-text-2\"><h5>Nous sommes disponibles 7 jours sur 7 et avons des horaires de bureau sp\u00e9cifiques avec tous les soignants membres du personnel. Outside of normal office hours you can receive an o&nbsp; call homcare giver at your nearby hospital if needed.<\/h5>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:30px;width:100%;\"><\/div><div class=\"fusion-text fusion-text-3\"><div id=\"quform-bef7b5\" class=\"quform quform-2 quform-theme-light quform-support-page-caching quform-is-first-page\"><form id=\"quform-form-bef7b5\" class=\"quform-form quform-form-2\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/364#quform-bef7b5\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:2,&quot;uniqueId&quot;:&quot;bef7b5&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;93&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;92&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;3&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;97&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;96&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;4&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;102&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;101&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;4&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;105&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;104&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;10&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;109&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;108&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;11&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;114&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;113&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;20&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;119&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;118&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;16&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;124&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;123&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;30&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;129&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;128&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;37&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;134&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;133&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;21&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;139&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;138&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;25&quot;,&quot;value&quot;:&quot;Other&quot;}]}},&quot;dependents&quot;:{&quot;92&quot;:[93],&quot;96&quot;:[97],&quot;101&quot;:[102],&quot;104&quot;:[105],&quot;108&quot;:[109],&quot;113&quot;:[114],&quot;118&quot;:[119],&quot;123&quot;:[124],&quot;128&quot;:[129],&quot;133&quot;:[134],&quot;138&quot;:[139]},&quot;elementIds&quot;:[93,97,102,105,109,114,119,124,129,134,139],&quot;dependentElementIds&quot;:[&quot;92&quot;,&quot;96&quot;,&quot;101&quot;,&quot;104&quot;,&quot;108&quot;,&quot;113&quot;,&quot;118&quot;,&quot;123&quot;,&quot;128&quot;,&quot;133&quot;,&quot;138&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:true,&quot;pages&quot;:[1,94,99,7,106,111,116,121,126,131,136,141],&quot;pageProgressType&quot;:&quot;percentage&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-2\"><input type=\"hidden\" name=\"quform_form_id\" value=\"2\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"bef7b5\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/pages\/364\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"1cpfhhplfe9adsEAZzY6pR4Jik1bg2zSBMnIDqWT\" \/><div class=\"quform-elements quform-elements-2 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-page-progress quform-page-progress-type-percentage\"><div class=\"quform-page-progress-bar\" style=\"width: 8%;\"><span class=\"quform-page-progress-text\"><span class=\"quform-page-progress-percentage\">8<\/span>%<\/span><\/div><\/div><div class=\"quform-element quform-element-page quform-page-1 quform-page-2_1 quform-cf quform-group-style-bordered quform-first-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_24 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006A9E; font-size: 16px;\"><strong>How many people require care?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_92 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_92 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_92 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_92\" id=\"quform_2_92_bef7b5_1\" class=\"quform-field quform-field-radio quform-field-2_92 quform-field-2_92_1\" value=\"Single Person\" \/><label for=\"quform_2_92_bef7b5_1\" class=\"quform-option-label quform-option-label-2_92_1\"><span class=\"quform-option-text\">Single Person<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_92\" id=\"quform_2_92_bef7b5_2\" class=\"quform-field quform-field-radio quform-field-2_92 quform-field-2_92_2\" value=\"Couple\" \/><label for=\"quform_2_92_bef7b5_2\" class=\"quform-option-label quform-option-label-2_92_2\"><span class=\"quform-option-text\">Couple<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_92\" id=\"quform_2_92_bef7b5_3\" class=\"quform-field quform-field-radio quform-field-2_92 quform-field-2_92_3\" value=\"Other\" \/><label for=\"quform_2_92_bef7b5_3\" class=\"quform-option-label quform-option-label-2_92_3\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_93 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_93\"><label class=\"quform-label-text\" for=\"quform_2_93_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_93 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_93 quform-cf\"><input type=\"text\" id=\"quform_2_93_bef7b5\" name=\"quform_2_93\" class=\"quform-field quform-field-text quform-field-2_93\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_2 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-next quform-button-next-default quform-button-next-2_2 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-94 quform-page-2_94 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_95 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>What kind of care is required?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_96 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_96 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_96 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_96\" id=\"quform_2_96_bef7b5_1\" class=\"quform-field quform-field-radio quform-field-2_96 quform-field-2_96_1\" value=\"Visiting\" \/><label for=\"quform_2_96_bef7b5_1\" class=\"quform-option-label quform-option-label-2_96_1\"><span class=\"quform-option-text\">Visiting<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_96\" id=\"quform_2_96_bef7b5_2\" class=\"quform-field quform-field-radio quform-field-2_96 quform-field-2_96_2\" value=\"Live in care\" \/><label for=\"quform_2_96_bef7b5_2\" class=\"quform-option-label quform-option-label-2_96_2\"><span class=\"quform-option-text\">Live in care<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_96\" id=\"quform_2_96_bef7b5_3\" class=\"quform-field quform-field-radio quform-field-2_96 quform-field-2_96_3\" value=\"Respite Care\" \/><label for=\"quform_2_96_bef7b5_3\" class=\"quform-option-label quform-option-label-2_96_3\"><span class=\"quform-option-text\">Respite Care<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_96\" id=\"quform_2_96_bef7b5_5\" class=\"quform-field quform-field-radio quform-field-2_96 quform-field-2_96_5\" value=\"I would like to discuss with the care provider\" \/><label for=\"quform_2_96_bef7b5_5\" class=\"quform-option-label quform-option-label-2_96_5\"><span class=\"quform-option-text\">I would like to discuss with the care provider<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_96\" id=\"quform_2_96_bef7b5_4\" class=\"quform-field quform-field-radio quform-field-2_96 quform-field-2_96_4\" value=\"Other\" \/><label for=\"quform_2_96_bef7b5_4\" class=\"quform-option-label quform-option-label-2_96_4\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_97 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_97\"><label class=\"quform-label-text\" for=\"quform_2_97_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_97 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_97 quform-cf\"><input type=\"text\" id=\"quform_2_97_bef7b5\" name=\"quform_2_97\" class=\"quform-field quform-field-text quform-field-2_97\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_98 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_98 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_98 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-99 quform-page-2_99 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_100 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>How many days per week is care required?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_101 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_101 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_101 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_101\" id=\"quform_2_101_bef7b5_1\" class=\"quform-field quform-field-radio quform-field-2_101 quform-field-2_101_1\" value=\"1 day\" \/><label for=\"quform_2_101_bef7b5_1\" class=\"quform-option-label quform-option-label-2_101_1\"><span class=\"quform-option-text\">1 day<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_101\" id=\"quform_2_101_bef7b5_2\" class=\"quform-field quform-field-radio quform-field-2_101 quform-field-2_101_2\" value=\"2-3 days\" \/><label for=\"quform_2_101_bef7b5_2\" class=\"quform-option-label quform-option-label-2_101_2\"><span class=\"quform-option-text\">2-3 days<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_101\" id=\"quform_2_101_bef7b5_3\" class=\"quform-field quform-field-radio quform-field-2_101 quform-field-2_101_3\" value=\"4-6 days\" \/><label for=\"quform_2_101_bef7b5_3\" class=\"quform-option-label quform-option-label-2_101_3\"><span class=\"quform-option-text\">4-6 days<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_101\" id=\"quform_2_101_bef7b5_5\" class=\"quform-field quform-field-radio quform-field-2_101 quform-field-2_101_5\" value=\"7 days\" \/><label for=\"quform_2_101_bef7b5_5\" class=\"quform-option-label quform-option-label-2_101_5\"><span class=\"quform-option-text\">7 days<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_101\" id=\"quform_2_101_bef7b5_4\" class=\"quform-field quform-field-radio quform-field-2_101 quform-field-2_101_4\" value=\"Other\" \/><label for=\"quform_2_101_bef7b5_4\" class=\"quform-option-label quform-option-label-2_101_4\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_102 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_102\"><label class=\"quform-label-text\" for=\"quform_2_102_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_102 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_102 quform-cf\"><input type=\"text\" id=\"quform_2_102_bef7b5\" name=\"quform_2_102\" class=\"quform-field quform-field-text quform-field-2_102\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_103 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_103 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_103 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-7 quform-page-2_7 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_27 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006A9E; font-size: 16px;\"><strong>What time(s) of day will the visits take place?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_104 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_104 quform-field-size-slim\"><div class=\"quform-input quform-input-checkbox quform-input-2_104 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_4\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_4\" value=\"Monday-Friday, daytime\" \/><label for=\"quform_2_104_bef7b5_4\" class=\"quform-option-label quform-option-label-2_104_4\"><span class=\"quform-option-text\">Monday-Friday, daytime<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_5\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_5\" value=\"Monday-Friday, evenings\" \/><label for=\"quform_2_104_bef7b5_5\" class=\"quform-option-label quform-option-label-2_104_5\"><span class=\"quform-option-text\">Monday-Friday, evenings<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_6\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_6\" value=\"Weekends, daytime\" \/><label for=\"quform_2_104_bef7b5_6\" class=\"quform-option-label quform-option-label-2_104_6\"><span class=\"quform-option-text\">Weekends, daytime<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_7\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_7\" value=\"Weekends, evenings\" \/><label for=\"quform_2_104_bef7b5_7\" class=\"quform-option-label quform-option-label-2_104_7\"><span class=\"quform-option-text\">Weekends, evenings<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_8\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_8\" value=\"Overnight\" \/><label for=\"quform_2_104_bef7b5_8\" class=\"quform-option-label quform-option-label-2_104_8\"><span class=\"quform-option-text\">Overnight<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_9\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_9\" value=\"All times of day\" \/><label for=\"quform_2_104_bef7b5_9\" class=\"quform-option-label quform-option-label-2_104_9\"><span class=\"quform-option-text\">All times of day<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_104[]\" id=\"quform_2_104_bef7b5_10\" class=\"quform-field quform-field-checkbox quform-field-2_104 quform-field-2_104_10\" value=\"Other\" \/><label for=\"quform_2_104_bef7b5_10\" class=\"quform-option-label quform-option-label-2_104_10\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_105 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_105\"><label class=\"quform-label-text\" for=\"quform_2_105_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_105 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_105 quform-cf\"><input type=\"text\" id=\"quform_2_105_bef7b5\" name=\"quform_2_105\" class=\"quform-field quform-field-text quform-field-2_105\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_8 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_8 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_8 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-106 quform-page-2_106 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_107 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>How long will each visit last?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_108 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_108 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_108 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_6\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_6\" value=\"30 minutes\" \/><label for=\"quform_2_108_bef7b5_6\" class=\"quform-option-label quform-option-label-2_108_6\"><span class=\"quform-option-text\">30 minutes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_7\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_7\" value=\"1 hour\" \/><label for=\"quform_2_108_bef7b5_7\" class=\"quform-option-label quform-option-label-2_108_7\"><span class=\"quform-option-text\">1 hour<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_8\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_8\" value=\"2-3 hours\" \/><label for=\"quform_2_108_bef7b5_8\" class=\"quform-option-label quform-option-label-2_108_8\"><span class=\"quform-option-text\">2-3 hours<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_9\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_9\" value=\"4-6 hours\" \/><label for=\"quform_2_108_bef7b5_9\" class=\"quform-option-label quform-option-label-2_108_9\"><span class=\"quform-option-text\">4-6 hours<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_10\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_10\" value=\"Longer than 6 hours\" \/><label for=\"quform_2_108_bef7b5_10\" class=\"quform-option-label quform-option-label-2_108_10\"><span class=\"quform-option-text\">Longer than 6 hours<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_108\" id=\"quform_2_108_bef7b5_11\" class=\"quform-field quform-field-radio quform-field-2_108 quform-field-2_108_11\" value=\"Other\" \/><label for=\"quform_2_108_bef7b5_11\" class=\"quform-option-label quform-option-label-2_108_11\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_109 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_109\"><label class=\"quform-label-text\" for=\"quform_2_109_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_109 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_109 quform-cf\"><input type=\"text\" id=\"quform_2_109_bef7b5\" name=\"quform_2_109\" class=\"quform-field quform-field-text quform-field-2_109\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_110 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_110 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_110 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-111 quform-page-2_111 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_112 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006A9E; font-size: 16px;\"><strong>Which of the following do you need help with?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_113 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_113 quform-field-size-slim\"><div class=\"quform-input quform-input-checkbox quform-input-2_113 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_11\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_11\" value=\"Attending social activities\" \/><label for=\"quform_2_113_bef7b5_11\" class=\"quform-option-label quform-option-label-2_113_11\"><span class=\"quform-option-text\">Attending social activities<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_12\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_12\" value=\"Continence support\" \/><label for=\"quform_2_113_bef7b5_12\" class=\"quform-option-label quform-option-label-2_113_12\"><span class=\"quform-option-text\">Continence support<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_13\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_13\" value=\"Cooking\" \/><label for=\"quform_2_113_bef7b5_13\" class=\"quform-option-label quform-option-label-2_113_13\"><span class=\"quform-option-text\">Cooking<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_14\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_14\" value=\"Household bills and admin\" \/><label for=\"quform_2_113_bef7b5_14\" class=\"quform-option-label quform-option-label-2_113_14\"><span class=\"quform-option-text\">Household bills and admin<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_15\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_15\" value=\"Housekeeping\" \/><label for=\"quform_2_113_bef7b5_15\" class=\"quform-option-label quform-option-label-2_113_15\"><span class=\"quform-option-text\">Housekeeping<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_16\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_16\" value=\"Medication\" \/><label for=\"quform_2_113_bef7b5_16\" class=\"quform-option-label quform-option-label-2_113_16\"><span class=\"quform-option-text\">Medication<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_17\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_17\" value=\"Personal care (washing, bathing, hair &amp; makeup)\" \/><label for=\"quform_2_113_bef7b5_17\" class=\"quform-option-label quform-option-label-2_113_17\"><span class=\"quform-option-text\">Personal care (washing, bathing, hair &amp; makeup)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_18\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_18\" value=\"Shopping\" \/><label for=\"quform_2_113_bef7b5_18\" class=\"quform-option-label quform-option-label-2_113_18\"><span class=\"quform-option-text\">Shopping<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_19\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_19\" value=\"Transport\" \/><label for=\"quform_2_113_bef7b5_19\" class=\"quform-option-label quform-option-label-2_113_19\"><span class=\"quform-option-text\">Transport<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_113[]\" id=\"quform_2_113_bef7b5_20\" class=\"quform-field quform-field-checkbox quform-field-2_113 quform-field-2_113_20\" value=\"Other\" \/><label for=\"quform_2_113_bef7b5_20\" class=\"quform-option-label quform-option-label-2_113_20\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_114 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_114\"><label class=\"quform-label-text\" for=\"quform_2_114_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_114 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_114 quform-cf\"><input type=\"text\" id=\"quform_2_114_bef7b5\" name=\"quform_2_114\" class=\"quform-field quform-field-text quform-field-2_114\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_115 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_115 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_115 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-116 quform-page-2_116 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_117 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>How mobile is the person needing care?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_118 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_118 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_118 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_118\" id=\"quform_2_118_bef7b5_12\" class=\"quform-field quform-field-radio quform-field-2_118 quform-field-2_118_12\" value=\"Fully mobile\" \/><label for=\"quform_2_118_bef7b5_12\" class=\"quform-option-label quform-option-label-2_118_12\"><span class=\"quform-option-text\">Fully mobile<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_118\" id=\"quform_2_118_bef7b5_13\" class=\"quform-field quform-field-radio quform-field-2_118 quform-field-2_118_13\" value=\"Walks with a frame\/stick\" \/><label for=\"quform_2_118_bef7b5_13\" class=\"quform-option-label quform-option-label-2_118_13\"><span class=\"quform-option-text\">Walks with a frame\/stick<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_118\" id=\"quform_2_118_bef7b5_14\" class=\"quform-field quform-field-radio quform-field-2_118 quform-field-2_118_14\" value=\"Needs a wheelchair to move around\" \/><label for=\"quform_2_118_bef7b5_14\" class=\"quform-option-label quform-option-label-2_118_14\"><span class=\"quform-option-text\">Needs a wheelchair to move around<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_118\" id=\"quform_2_118_bef7b5_15\" class=\"quform-field quform-field-radio quform-field-2_118 quform-field-2_118_15\" value=\"Confined to bed\" \/><label for=\"quform_2_118_bef7b5_15\" class=\"quform-option-label quform-option-label-2_118_15\"><span class=\"quform-option-text\">Confined to bed<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_118\" id=\"quform_2_118_bef7b5_16\" class=\"quform-field quform-field-radio quform-field-2_118 quform-field-2_118_16\" value=\"Other\" \/><label for=\"quform_2_118_bef7b5_16\" class=\"quform-option-label quform-option-label-2_118_16\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_119 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_119\"><label class=\"quform-label-text\" for=\"quform_2_119_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_119 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_119 quform-cf\"><input type=\"text\" id=\"quform_2_119_bef7b5\" name=\"quform_2_119\" class=\"quform-field quform-field-text quform-field-2_119\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_120 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_120 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_120 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-121 quform-page-2_121 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_122 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006A9E; font-size: 16px;\"><strong>Which of the following medical conditions\/care needs does the client have?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_123 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_123 quform-field-size-slim\"><div class=\"quform-input quform-input-checkbox quform-input-2_123 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_21\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_21\" value=\"None\" \/><label for=\"quform_2_123_bef7b5_21\" class=\"quform-option-label quform-option-label-2_123_21\"><span class=\"quform-option-text\">None<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_22\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_22\" value=\"Alzheimers\" \/><label for=\"quform_2_123_bef7b5_22\" class=\"quform-option-label quform-option-label-2_123_22\"><span class=\"quform-option-text\">Alzheimers<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_23\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_23\" value=\"Arthritis\" \/><label for=\"quform_2_123_bef7b5_23\" class=\"quform-option-label quform-option-label-2_123_23\"><span class=\"quform-option-text\">Arthritis<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_24\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_24\" value=\"Dementia\" \/><label for=\"quform_2_123_bef7b5_24\" class=\"quform-option-label quform-option-label-2_123_24\"><span class=\"quform-option-text\">Dementia<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_25\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_25\" value=\"Diabetes\" \/><label for=\"quform_2_123_bef7b5_25\" class=\"quform-option-label quform-option-label-2_123_25\"><span class=\"quform-option-text\">Diabetes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_26\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_26\" value=\"Incontinence\" \/><label for=\"quform_2_123_bef7b5_26\" class=\"quform-option-label quform-option-label-2_123_26\"><span class=\"quform-option-text\">Incontinence<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_27\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_27\" value=\"Palliative care\" \/><label for=\"quform_2_123_bef7b5_27\" class=\"quform-option-label quform-option-label-2_123_27\"><span class=\"quform-option-text\">Palliative care<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_28\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_28\" value=\"Parkinson&#039;s\" \/><label for=\"quform_2_123_bef7b5_28\" class=\"quform-option-label quform-option-label-2_123_28\"><span class=\"quform-option-text\">Parkinson's<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_29\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_29\" value=\"Physical therapy\" \/><label for=\"quform_2_123_bef7b5_29\" class=\"quform-option-label quform-option-label-2_123_29\"><span class=\"quform-option-text\">Physical therapy<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_123[]\" id=\"quform_2_123_bef7b5_30\" class=\"quform-field quform-field-checkbox quform-field-2_123 quform-field-2_123_30\" value=\"Other\" \/><label for=\"quform_2_123_bef7b5_30\" class=\"quform-option-label quform-option-label-2_123_30\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_124 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_124\"><label class=\"quform-label-text\" for=\"quform_2_124_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_124 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_124 quform-cf\"><input type=\"text\" id=\"quform_2_124_bef7b5\" name=\"quform_2_124\" class=\"quform-field quform-field-text quform-field-2_124\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_125 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_125 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_125 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-126 quform-page-2_126 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_127 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006A9E; font-size: 16px;\"><strong>Which of the following medical conditions does the client have?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_128 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_128 quform-field-size-slim\"><div class=\"quform-input quform-input-checkbox quform-input-2_128 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_31\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_31\" value=\"None\" \/><label for=\"quform_2_128_bef7b5_31\" class=\"quform-option-label quform-option-label-2_128_31\"><span class=\"quform-option-text\">None<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_32\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_32\" value=\"Alzheimers\" \/><label for=\"quform_2_128_bef7b5_32\" class=\"quform-option-label quform-option-label-2_128_32\"><span class=\"quform-option-text\">Alzheimers<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_33\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_33\" value=\"Arthritis\" \/><label for=\"quform_2_128_bef7b5_33\" class=\"quform-option-label quform-option-label-2_128_33\"><span class=\"quform-option-text\">Arthritis<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_34\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_34\" value=\"Dementia\" \/><label for=\"quform_2_128_bef7b5_34\" class=\"quform-option-label quform-option-label-2_128_34\"><span class=\"quform-option-text\">Dementia<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_35\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_35\" value=\"Diabetes\" \/><label for=\"quform_2_128_bef7b5_35\" class=\"quform-option-label quform-option-label-2_128_35\"><span class=\"quform-option-text\">Diabetes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_36\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_36\" value=\"Incontinence\" \/><label for=\"quform_2_128_bef7b5_36\" class=\"quform-option-label quform-option-label-2_128_36\"><span class=\"quform-option-text\">Incontinence<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_38\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_38\" value=\"Post Hospitalization Care\" \/><label for=\"quform_2_128_bef7b5_38\" class=\"quform-option-label quform-option-label-2_128_38\"><span class=\"quform-option-text\">Post Hospitalization Care<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_39\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_39\" value=\"Mental Health Management\" \/><label for=\"quform_2_128_bef7b5_39\" class=\"quform-option-label quform-option-label-2_128_39\"><span class=\"quform-option-text\">Mental Health Management<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_128[]\" id=\"quform_2_128_bef7b5_37\" class=\"quform-field quform-field-checkbox quform-field-2_128 quform-field-2_128_37\" value=\"Other\" \/><label for=\"quform_2_128_bef7b5_37\" class=\"quform-option-label quform-option-label-2_128_37\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_129 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_129\"><label class=\"quform-label-text\" for=\"quform_2_129_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_129 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_129 quform-cf\"><input type=\"text\" id=\"quform_2_129_bef7b5\" name=\"quform_2_129\" class=\"quform-field quform-field-text quform-field-2_129\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_130 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_130 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_130 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-131 quform-page-2_131 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_132 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>When do you want the care to begin?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_133 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_133 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_133 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_133\" id=\"quform_2_133_bef7b5_17\" class=\"quform-field quform-field-radio quform-field-2_133 quform-field-2_133_17\" value=\"As soon as possible\" \/><label for=\"quform_2_133_bef7b5_17\" class=\"quform-option-label quform-option-label-2_133_17\"><span class=\"quform-option-text\">As soon as possible<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_133\" id=\"quform_2_133_bef7b5_18\" class=\"quform-field quform-field-radio quform-field-2_133 quform-field-2_133_18\" value=\"Within the next week\" \/><label for=\"quform_2_133_bef7b5_18\" class=\"quform-option-label quform-option-label-2_133_18\"><span class=\"quform-option-text\">Within the next week<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_133\" id=\"quform_2_133_bef7b5_19\" class=\"quform-field quform-field-radio quform-field-2_133 quform-field-2_133_19\" value=\"Within the next month\" \/><label for=\"quform_2_133_bef7b5_19\" class=\"quform-option-label quform-option-label-2_133_19\"><span class=\"quform-option-text\">Within the next month<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_133\" id=\"quform_2_133_bef7b5_20\" class=\"quform-field quform-field-radio quform-field-2_133 quform-field-2_133_20\" value=\"Within the next 3 months\" \/><label for=\"quform_2_133_bef7b5_20\" class=\"quform-option-label quform-option-label-2_133_20\"><span class=\"quform-option-text\">Within the next 3 months<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_133\" id=\"quform_2_133_bef7b5_21\" class=\"quform-field quform-field-radio quform-field-2_133 quform-field-2_133_21\" value=\"Other\" \/><label for=\"quform_2_133_bef7b5_21\" class=\"quform-option-label quform-option-label-2_133_21\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_134 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_134\"><label class=\"quform-label-text\" for=\"quform_2_134_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_134 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_134 quform-cf\"><input type=\"text\" id=\"quform_2_134_bef7b5\" name=\"quform_2_134\" class=\"quform-field quform-field-text quform-field-2_134\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_135 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_135 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_135 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-136 quform-page-2_136 quform-cf quform-group-style-bordered\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_137 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>When is the care required?<\/strong><\/p><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-2_138 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-2_138 quform-field-size-slim\"><div class=\"quform-input quform-input-radio quform-input-2_138 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-theme quform-button-width-full quform-button-icon-left\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_138\" id=\"quform_2_138_bef7b5_22\" class=\"quform-field quform-field-radio quform-field-2_138 quform-field-2_138_22\" value=\"As soon as possible\" \/><label for=\"quform_2_138_bef7b5_22\" class=\"quform-option-label quform-option-label-2_138_22\"><span class=\"quform-option-text\">As soon as possible<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_138\" id=\"quform_2_138_bef7b5_23\" class=\"quform-field quform-field-radio quform-field-2_138 quform-field-2_138_23\" value=\"Within the next week\" \/><label for=\"quform_2_138_bef7b5_23\" class=\"quform-option-label quform-option-label-2_138_23\"><span class=\"quform-option-text\">Within the next week<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_138\" id=\"quform_2_138_bef7b5_24\" class=\"quform-field quform-field-radio quform-field-2_138 quform-field-2_138_24\" value=\"Within the next month\" \/><label for=\"quform_2_138_bef7b5_24\" class=\"quform-option-label quform-option-label-2_138_24\"><span class=\"quform-option-text\">Within the next month<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_138\" id=\"quform_2_138_bef7b5_25\" class=\"quform-field quform-field-radio quform-field-2_138 quform-field-2_138_25\" value=\"Other\" \/><label for=\"quform_2_138_bef7b5_25\" class=\"quform-option-label quform-option-label-2_138_25\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_139 quform-cf quform-labels-inside quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_139\"><label class=\"quform-label-text\" for=\"quform_2_139_bef7b5\">Other<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_139 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_139 quform-cf\"><input type=\"text\" id=\"quform_2_139_bef7b5\" name=\"quform_2_139\" class=\"quform-field quform-field-text quform-field-2_139\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_140 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_140 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-next quform-button-next-default quform-button-next-2_140 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><span class=\"quform-button-icon quform-button-next-icon\"><i class=\"qicon-arrow_forward\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-141 quform-page-2_141 quform-cf quform-group-style-bordered quform-last-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-2_142 quform-cf\"><div class=\"quform-spacer\"><p style=\"text-align: center; color: #006a9e; font-size: 16px;\"><strong>Where do you need the Home Care Specialist?<\/strong><\/p>\n<p style=\"text-align: center;\">The postcode or town for the address where you want the Home Care Specialist.<\/p><\/div><\/div><div class=\"quform-element quform-element-name quform-element-2_146 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_146\"><label class=\"quform-label-text\" id=\"quform_2_146_bef7b5_label\">Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-name quform-inner-2_146 quform-field-size-slim\"><div class=\"quform-input quform-input-name quform-input-2_146 quform-cf\"><div class=\"quform-element-row quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_146_2 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_146_2 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_146_2 quform-cf\"><input type=\"text\" id=\"quform_2_146_2_bef7b5\" name=\"quform_2_146[2]\" class=\"quform-field quform-field-text quform-field-2_146_2\" placeholder=\"Name\" aria-labelledby=\"quform_2_146_bef7b5_label\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_150 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_150\"><label class=\"quform-label-text\" for=\"quform_2_150_bef7b5\">Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_150 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_150 quform-cf\"><input type=\"text\" id=\"quform_2_150_bef7b5\" name=\"quform_2_150\" class=\"quform-field quform-field-text quform-field-2_150\" placeholder=\"Email\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_152 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_152\"><label class=\"quform-label-text\" for=\"quform_2_152_bef7b5\">Phone<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_152 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_152 quform-cf\"><input type=\"text\" id=\"quform_2_152_bef7b5\" name=\"quform_2_152\" class=\"quform-field quform-field-text quform-field-2_152\" placeholder=\"Email\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_153 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_153\"><label class=\"quform-label-text\" for=\"quform_2_153_bef7b5\">Location<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_153 quform-field-size-slim\"><div class=\"quform-input quform-input-text quform-input-2_153 quform-cf\"><input type=\"text\" id=\"quform_2_153_bef7b5\" name=\"quform_2_153\" class=\"quform-field quform-field-text quform-field-2_153\" placeholder=\"Email\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_145 quform-cf quform-button-style-theme quform-button-size-fat quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_145 quform-button-icon-left\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-icon quform-button-back-icon\"><i class=\"qicon-arrow_back\"><\/i><\/span><span class=\"quform-button-text quform-button-back-text\">Back<\/span><\/button><\/div><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-2_145 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Send<\/span><span class=\"quform-button-icon quform-button-submit-icon\"><i class=\"qicon-check\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_2_0_bef7b5\">This field should be left blank<\/label><input type=\"text\" id=\"quform_2_0_bef7b5\" name=\"quform_2_0\" class=\"quform-field quform-field-tree quform-field-2_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_2_5 2_5 fusion-flex-column\" style=\"--awb-padding-top:100px;--awb-padding-right:10%;--awb-padding-bottom:100px;--awb-padding-left:10%;--awb-bg-color:var(--awb-color2);--awb-bg-color-hover:var(--awb-color2);--awb-bg-size:cover;--awb-width-large:40%;--awb-margin-top-large:0px;--awb-spacing-right-large:4.8%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:40%;--awb-spacing-right-medium:4.8%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-bottom:10px;\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">RENSEIGNEMENTS G\u00c9N\u00c9RAUX<\/h4><\/div><div class=\"fusion-separator\" style=\"align-self: flex-start;margin-right:auto;margin-top:0px;margin-bottom:30px;width:100%;max-width:40px;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:var(--awb-color4);border-color:var(--awb-color4);border-top-width:2px;\"><\/div><\/div><ul style=\"--awb-size:17px;--awb-iconcolor:#ffffff;--awb-line-height:28.9px;--awb-icon-width:28.9px;--awb-icon-height:28.9px;--awb-icon-margin:11.9px;--awb-content-margin:40.8px;--awb-circlecolor:var(--awb-color4);--awb-circle-yes-font-size:14.96px;\" class=\"fusion-checklist fusion-checklist-1 fusion-checklist-default type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-at fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p>info@summitss.ca<\/p>\n<\/div><\/li><\/ul><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:50px;width:100%;\"><\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-bottom:10px;\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">HEURES DE TRAVAIL<\/h4><\/div><div class=\"fusion-separator\" style=\"align-self: flex-start;margin-right:auto;margin-top:0px;margin-bottom:30px;width:100%;max-width:40px;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:var(--awb-color4);border-color:var(--awb-color4);border-top-width:2px;\"><\/div><\/div><div class=\"fusion-text fusion-text-4\"><div class=\"table-2\">\n<table width=\"100%\">\n<tbody>\n<tr>\n<td style=\"text-align: left;\">Lundi vendredi<\/td>\n<td style=\"text-align: right;\">8:00 &#8211; 5:00<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: left;\">Samedi<\/td>\n<td style=\"text-align: right;\">9:00 &#8211; 5:00<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: left;\">Dimanche<\/td>\n<td style=\"text-align: right;\">11:00 &#8211; 4:00<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:50px;width:100%;\"><\/div><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-bottom:10px;\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">D\u00c9PARTEMENTS<\/h4><\/div><div class=\"fusion-separator\" style=\"align-self: flex-start;margin-right:auto;margin-top:0px;margin-bottom:30px;width:100%;max-width:40px;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:var(--awb-color4);border-color:var(--awb-color4);border-top-width:2px;\"><\/div><\/div><ul style=\"--awb-iconcolor:var(--awb-color4);--awb-line-height:27.2px;--awb-icon-width:27.2px;--awb-icon-height:27.2px;--awb-icon-margin:11.2px;--awb-content-margin:38.4px;\" class=\"fusion-checklist fusion-checklist-2 fusion-checklist-default type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/dementia-alzheimer-care\/\">Soins pour la d\u00e9mence-Alzheimer<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/palliative-care\/\">Soins palliatifs<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/disability-support\/\">Aide aux personnes handicap\u00e9es<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/post-hospitalization-care\/\">Soins post-hospitalisation<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/personal-home-care-assistance-for-seniors\/\">Aide personnelle aux soins \u00e0 domicile pour les personnes \u00e2g\u00e9es<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"https:\/\/summitss.ca\/service\/companionship-respite-care\/\">Compagnonnage et soins de r\u00e9pit<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-check-circle fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/summitss.ca\/service\/mental-health-management\/\">Gestion de la sant\u00e9 mentale<\/a><\/p>\n<\/div><\/li><\/ul><\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-364","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/pages\/364","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/comments?post=364"}],"version-history":[{"count":1,"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/pages\/364\/revisions"}],"predecessor-version":[{"id":366,"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/pages\/364\/revisions\/366"}],"wp:attachment":[{"href":"https:\/\/summitss.ca\/fr\/wp-json\/wp\/v2\/media?parent=364"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}