{"id":4561,"date":"2023-06-30T11:07:55","date_gmt":"2023-06-30T15:07:55","guid":{"rendered":"https:\/\/www.pharmaciecellinigauvin.ca\/?page_id=4561"},"modified":"2023-06-30T11:30:33","modified_gmt":"2023-06-30T15:30:33","slug":"membership","status":"publish","type":"page","link":"https:\/\/pharmaciecellinigauvin.ca\/en\/membership\/","title":{"rendered":"Membership"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column css=&#8221;.vc_custom_1687362777729{margin-top: 30px !important;margin-bottom: 30px !important;}&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4564-o1\" lang=\"fr-CA\" dir=\"ltr\" data-wpcf7-id=\"4564\">\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\/4561#wpcf7-f4564-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4564\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_CA\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4564-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;:4564,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;-1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;-1&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Veuillez transf\\u00e9rer seulement ces ordonnances (indiquez le nom ou le num\\u00e9ro complet des ordonnances \\u00e0 transf\\u00e9rer) *Certaines restrictions s\\u2019appliquent.&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;notice_dismissed_rollback-cf7-5.9.5&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.8&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"wrap\">\n\t<div class=\"col-2\">\n\t\t<p><label> First name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-2\">\n\t\t<p><label> Last name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"wrap\">\n\t<div class=\"col-2\">\n\t\t<p><label> E-mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"e-mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"e-mail\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-2\">\n\t\t<p><label> Date of birth*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-767\"><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=\"date-767\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"wrap\">\n\t<div class=\"col-2\">\n\t\t<p><label> Address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-2\">\n\t\t<p><label> City<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"wrap\">\n\t<div class=\"col-3\">\n\t\t<p><label> Province<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"province-en\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"province-en\"><option value=\"Select a province\">Select a province<\/option><option value=\"Alberta\">Alberta<\/option><option value=\"British Columbia\">British Columbia<\/option><option value=\"Manitoba\">Manitoba<\/option><option value=\"New Brunswick\">New Brunswick<\/option><option value=\"Newfoundland and Labrador\">Newfoundland and Labrador<\/option><option value=\"Nova Scotia\">Nova Scotia<\/option><option value=\"Ontario\">Ontario<\/option><option value=\"Prince Edward Island\">Prince Edward Island<\/option><option value=\"Quebec\">Quebec<\/option><option value=\"Saskatchewan\">Saskatchewan<\/option><option value=\"Yukon\">Yukon<\/option><option value=\"Northwest Territories\">Northwest Territories<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-3\">\n\t\t<p><label> Postal code<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"postal-code\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-3\">\n\t\t<p><label> Telephone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-914\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-914\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"wrap\">\n\t<div class=\"col-2\">\n\t\t<p><label> Health insurance number (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nam-en\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nam-en\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-2\">\n\t<\/div>\n<\/div>\n<hr \/>\n<p class\"bold-text\">Information about your current pharmacy\n<\/p>\n<div class=\"wrap\">\n\t<div class=\"col-2\">\n\t\t<p><label> Pharmacy Name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pharmacy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pharmacy\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-2\">\n\t\t<p><label> Pharmacy Phone Number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-pharmacy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-pharmacy\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<hr \/>\n<p class\"text\">Transfer of Prescriptions<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-618\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-618\" value=\"Please transfer my entire file.\" \/><span class=\"wpcf7-list-item-label\">Please transfer my entire file.<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-618\" value=\"Please transfer only certain prescriptions. (We will contact you to confirm details).\" \/><span class=\"wpcf7-list-item-label\">Please transfer only certain prescriptions. (We will contact you to confirm details).<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<hr \/>\n<p class\"text\">Are you insured?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-334\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-334\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-334\" value=\"RAMQ\" \/><span class=\"wpcf7-list-item-label\">RAMQ<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-334\" value=\"Private insurance\" \/><span class=\"wpcf7-list-item-label\">Private insurance<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<hr \/>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-129\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-129[]\" value=\"I agree to send this information to the pharmacy selected above.\" \/><span class=\"wpcf7-list-item-label\">I agree to send this information to the pharmacy selected above.<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-129[]\" value=\"I understand that some prescriptions cannot be transferred. In this case, the pharmacist will contact me.\" \/><span class=\"wpcf7-list-item-label\">I understand that some prescriptions cannot be transferred. In this case, the pharmacist will contact me.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Request Transfer\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column css=&#8221;.vc_custom_1687362777729{margin-top: 30px !important;margin-bottom: 30px !important;}&#8221;][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4561","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/pages\/4561","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/comments?post=4561"}],"version-history":[{"count":2,"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/pages\/4561\/revisions"}],"predecessor-version":[{"id":4565,"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/pages\/4561\/revisions\/4565"}],"wp:attachment":[{"href":"https:\/\/pharmaciecellinigauvin.ca\/en\/wp-json\/wp\/v2\/media?parent=4561"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}