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Submitted URL:
https://survey.genolier-patient-services.com/
Effective URL:
https://form.jotformeu.com/83032113599354/
Submission: On September 14 via automatic, source certstream-suspicious (September 14th 2021, 3:48:22 am UTC) — Scanned from DE

Form analysis
1 forms found in the DOM

Name: form_83032113599354 — POST https://submit.jotformeu.com/submit/83032113599354/

<form role="main" class="jotform-form" id="83032113599354" name="form_83032113599354" action="https://submit.jotformeu.com/submit/83032113599354/" method="post" autocomplete="on" novalidate="true"><input type="hidden" name="formID"
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        <li data-lang="ru" class="ru">Russian</li>
        <li data-lang="en" class="en">English (US)</li>
        <li data-lang="it" class="it">Italiano</li>
        <li data-lang="de" class="de">Deutsch</li>
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        <div class="jfCard canMoveAuto" data-type="control_imagechoice" style="max-height: 1200px;">
          <div class="jfCard-index">1</div>
          <div class="jfCard-question" style="overflow-y: auto; max-height: 1197.68px;">
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              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer">Dans quelle parmi ces cliniques séjournez-vous&nbsp;?</span><span class="jfRequiredStar">* <span
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              <div class="jfField form-radio-item"><label data-id="label_input_24_2" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
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              <div class="jfField form-radio-item"><label data-id="label_input_24_3" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
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                    <div class="jfRadio-image" style="background-image:url(&quot;https://www.jotform.com/uploads/mvibert/form_files/PKB_logo.5c52b5e881d8d5.20162485.jpg&quot;)"><img alt="Privatklinik Bethanien"
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                      class="jfRadio-visual" alt="Radio" style="display:none"><span class="jfRadio-labelText">Privatklinik Bethanien</span>
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              <div class="jfField jfField-lastRowItem form-radio-item"><label data-id="label_input_24_4" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
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                    <div class="jfRadio-image" style="background-image:url(&quot;https://www.jotform.com/uploads/mvibert/form_files/PKL_logo.5c52b5f82a6c28.51373076.jpg&quot;)"><img alt="Privatklinik Lindberg"
                        src="https://www.jotform.com/uploads/mvibert/form_files/PKL_logo.5c52b5f82a6c28.51373076.jpg" style="display:none"></div><span class="jfRadio-customInput"><span class="jfRadio-customInputIcon"></span></span><img
                      class="jfRadio-visual" alt="Radio" style="display:none"><span class="jfRadio-labelText">Privatklinik Lindberg</span>
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              <div class="jfField jfField-lastRowItem form-radio-item"><label data-id="label_input_24_5" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
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                    <div class="jfRadio-image" style="background-image:url(&quot;https://www.jotform.com/uploads/mvibert/form_files/CVA_logo.5c52b619c14f82.78491359.jpg&quot;)"><img alt="Clinique Valmont"
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                      class="jfRadio-visual" alt="Radio" style="display:none"><span class="jfRadio-labelText">Clinique Valmont</span>
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              <div class="jfField jfField-lastRowItem form-radio-item"><label data-id="label_input_24_6" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
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                    <div class="jfRadio-image" style="background-image:url(&quot;https://www.jotform.com/uploads/mvibert/form_files/CGB_logo.5c9de17e10bfb1.49841036.jpg&quot;)"><img alt="Clinique Générale Beaulieu"
                        src="https://www.jotform.com/uploads/mvibert/form_files/CGB_logo.5c9de17e10bfb1.49841036.jpg" style="display:none"></div><span class="jfRadio-customInput"><span class="jfRadio-customInputIcon"></span></span><img
                      class="jfRadio-visual" alt="Radio" style="display:none"><span class="jfRadio-labelText">Clinique Générale Beaulieu</span>
                  </div>
                </label></div>
              <div class="jfField jfField-lastRowItem form-radio-item"><label data-id="label_input_24_7" class="jfRadio withImage "><input type="radio" class="jfRadio-input form-radio validate[required]" name="q24_dansQuelle[]"
                    value="Nescens Clinique de Genolier|https://www.jotform.com/uploads/mvibert/form_files/NCG_logo.5c52b606c79cc9.24954674.jpg" id="input_24_7" required="" data-calcvalue="NCG">
                  <div class="jfRadio-label">
                    <div class="jfRadio-image" style="background-image:url(&quot;https://www.jotform.com/uploads/mvibert/form_files/NCG_logo.5c52b606c79cc9.24954674.jpg&quot;)"><img alt="Nescens Clinique de Genolier"
                        src="https://www.jotform.com/uploads/mvibert/form_files/NCG_logo.5c52b606c79cc9.24954674.jpg" style="display:none"></div><span class="jfRadio-customInput"><span class="jfRadio-customInputIcon"></span></span><img
                      class="jfRadio-visual" alt="Radio" style="display:none"><span class="jfRadio-labelText">Nescens Clinique de Genolier</span>
                  </div>
                </label></div>
            </div>
          </div>
          <div class="jfCard-actions"><button style="display:none" type="button" class="jfInput-button forPrev u-left" data-component="button" aria-label="Précédent">Précédent</button><button style="display:block" type="button"
              class="jfInput-button forNext u-right" data-component="button" aria-label="suivant">suivant</button><button style="display:none" type="submit" class="jfInput-button forSubmit u-right" data-component="button"
              aria-label="Envoyer !">Envoyer !</button>
            <div class="cf">
              <div class="jfCard-actionsNotification" aria-live="polite">
                <div class="jfPressEnter isHidden" aria-hidden="true">Press<br>Enter</div>
              </div>
            </div>
            <div class="jfCard-disableSubmitError"></div>
          </div>
        </div>
      </div>
    </li>
    <li class="form-line" data-type="control_matrix" id="id_9">
      <div id="cid_9" class="jfCard-wrapper nextQuestion transition-all-015s" style="width: 940px; margin-left: 0px;" aria-hidden="true">
        <div class="jfCard" data-type="control_matrix" style="max-height: 1200px;">
          <div class="jfCard-index">2</div>
          <div class="jfCard-question" style="max-height: 1197.68px; overflow-y: auto;">
            <div class="jfQuestion-fullscreen isHidden" aria-hidden="true" role="button" aria-label="fullscreen mode" tabindex="-1"></div><label for="input_9" class="jfQuestion-label isCenterAlign" id="label_9"
              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer">Avant votre arrivée</span><span class="jfRequiredStar">* <span class="jfRequiredStar-message">This field is
                  required.</span></span></label><span class="jfQuestion-description" id="input_9_description"><span></span></span>
            <div class="jfCard-mobileError jsMobileErrorWrapper"></div>
            <div class="jfQuestion-fields" data-component="matrix2" data-wrapper-react="true">
              <div class="jfField" id="matrix_9" data-type="Emoji Slider" style="width:100%">
                <div class="jfMatrix isFun forDesktop forEmojiSlider">
                  <div class="jfMatrixTable-wrapper jfMatrix-innerScrollableArea">
                    <div class="jfMatrixLabelList">
                      <div class="jfMatrixLabelList-item"><label id="label_9_row_0">Comment jugez-vous votre premier contact avec notre clinique ? (amabilité de l’interlocuteur, efficacité et rapidité de réponse)</label></div>
                      <div class="jfMatrixLabelList-item"><label id="label_9_row_1">Comment qualifiez-vous la qualité des informations obtenues ? (devis, programme médical et support à votre voyage)</label></div>
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                    <div class="jfMatrixInputList">
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                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
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                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
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                              <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
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                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep"
                              data-scale="75.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_4_3" name="q10_pendantVotre[4]" value="6" class="form-radio validate[required, requireEveryRow]"
                                  tabindex="-1" aria-label="Satisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label
                                class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_4_4" name="q10_pendantVotre[4]" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1"
                                  aria-label="Extremely Satisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span></div>
                          <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                              <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
                            </button></div>
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                      <div class="jfMatrixInputList-item js-matrixRow " data-required="Yes" style="height: 43px;">
                        <div class="jfMatrixScale">
                          <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_5_0" name="q10_pendantVotre[5]" value="1"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
                              class="scaleSep" data-scale="25.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_5_1" name="q10_pendantVotre[5]" value="2"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
                              class="scaleSep" data-scale="50.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_5_2" name="q10_pendantVotre[5]" value="4"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep"
                              data-scale="75.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_5_3" name="q10_pendantVotre[5]" value="6" class="form-radio validate[required, requireEveryRow]"
                                  tabindex="-1" aria-label="Satisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label
                                class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_5_4" name="q10_pendantVotre[5]" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1"
                                  aria-label="Extremely Satisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span></div>
                          <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                              <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
                            </button></div>
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                      <div class="jfMatrixInputList-item js-matrixRow " data-required="Yes" style="height: 63px;">
                        <div class="jfMatrixScale">
                          <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_6_0" name="q10_pendantVotre[6]" value="1"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
                              class="scaleSep" data-scale="25.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_6_1" name="q10_pendantVotre[6]" value="2"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span
                              class="scaleSep" data-scale="50.00"><label class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_6_2" name="q10_pendantVotre[6]" value="4"
                                  class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep"
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                                  tabindex="-1" aria-label="Satisfied"><span class="jfMatrix-customRadio"><span class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label
                                class="form-matrix-values jfMatrix-inputWrapper forRadio"><input type="radio" id="input_10_6_4" name="q10_pendantVotre[6]" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1"
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                          <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                              <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                              <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
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                <div class="jfMatrix forMobile forEmojiSlider hidden-matrix">
                  <div class="jfMobileMatrix-questionList">
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                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="1">Comment évaluez-vous la qualité de la prise en charge médicale ? (fréquence des visites et disponibilité du médecin)</div>
                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="2">Comment évaluez-vous la qualité de l’accompagnement par votre coordinatrice médicale personnelle ?</div>
                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="3">Comment qualifiez-vous, de manière générale, la disponibilité et le professionnalisme des collaborateurs ?</div>
                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="4">Comment jugez-vous la qualité des repas ?</div>
                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="5">Comment qualifiez-vous le confort de la chambre?</div>
                    <div class="jfMobileMatrix-question jfMobileMatrix-row" data-order="6">Comment jugez-vous le service de housekeeping (tenue de votre chambre) ?</div>
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                  <div class="jfMobileMatrix-content slider">
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                        <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio" id="input_10_0_0_disabled" value="1"
                                class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied" data-name="q10_pendantVotre[0]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="25.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_0_1_disabled" value="2" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied" data-name="q10_pendantVotre[0]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="50.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_0_2_disabled" value="4" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral" data-name="q10_pendantVotre[0]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="75.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_0_3_disabled" value="6" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Satisfied" data-name="q10_pendantVotre[0]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_0_4_disabled" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Satisfied" data-name="q10_pendantVotre[0]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span></div>
                        <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                            <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
                          </button></div>
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                    <div class="jfMatrixInputList-item js-matrixRow  isHidden" data-required="Yes">
                      <div class="jfMatrixScale">
                        <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio" id="input_10_1_0_disabled" value="1"
                                class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied" data-name="q10_pendantVotre[1]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="25.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_1_1_disabled" value="2" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied" data-name="q10_pendantVotre[1]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="50.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
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                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="75.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_1_3_disabled" value="6" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Satisfied" data-name="q10_pendantVotre[1]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_1_4_disabled" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Satisfied" data-name="q10_pendantVotre[1]"><span class="jfMatrix-customRadio"><span
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                        <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                            <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
                          </button></div>
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                    <div class="jfMatrixInputList-item js-matrixRow  isHidden" data-required="Yes">
                      <div class="jfMatrixScale">
                        <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio" id="input_10_2_0_disabled" value="1"
                                class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied" data-name="q10_pendantVotre[2]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="25.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
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                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="50.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_2_2_disabled" value="4" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral" data-name="q10_pendantVotre[2]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="75.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_2_3_disabled" value="6" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Satisfied" data-name="q10_pendantVotre[2]"><span class="jfMatrix-customRadio"><span
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                                id="input_10_2_4_disabled" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Satisfied" data-name="q10_pendantVotre[2]"><span class="jfMatrix-customRadio"><span
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                        <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                            <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
                          </button></div>
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                    <div class="jfMatrixInputList-item js-matrixRow  isHidden" data-required="Yes">
                      <div class="jfMatrixScale">
                        <div class="jfMatrixScale-sep"><span class="scaleSep" data-scale="0.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio" id="input_10_3_0_disabled" value="1"
                                class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Dissatisfied" data-name="q10_pendantVotre[3]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="25.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_3_1_disabled" value="2" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Dissatisfied" data-name="q10_pendantVotre[3]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="50.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_3_2_disabled" value="4" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Neutral" data-name="q10_pendantVotre[3]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="75.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_3_3_disabled" value="6" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Satisfied" data-name="q10_pendantVotre[3]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span><span class="scaleSep" data-scale="100.00"><label class="jfMatrix-inputWrapper forRadio form-matrix-values-disabled"><input type="radio"
                                id="input_10_3_4_disabled" value="7" class="form-radio validate[required, requireEveryRow]" tabindex="-1" aria-label="Extremely Satisfied" data-name="q10_pendantVotre[3]"><span class="jfMatrix-customRadio"><span
                                  class="jfMatrix-customRadioInner"></span></span></label></span></div>
                        <div class="jfMatrixScale-item" style="width:50.00%" aria-hidden="true"><button class="jfMatrixScale-button noTranslate" type="button" aria-valuenow="50" role="slider" aria-valuemax="100.00" aria-valuemin="0.00">
                            <div class="jfMatrixScale-label " data-scale="0.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/1.png" alt="Extremely Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="25.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/2.png" alt="Dissatisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label isVisible" data-scale="50.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/4.png" alt="Neutral" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="75.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/6.png" alt="Satisfied" class="sliderImage"></div>
                            <div class="jfMatrixScale-label " data-scale="100.00"><img src="https://cdn.jotfor.ms/images/seven_scale_icons/7.png" alt="Extremely Satisfied" class="sliderImage"></div>
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                    <div class="jfMatrixInputList-item js-matrixRow  isHidden" data-required="Yes">
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          <div class="jfCard-index">6</div>
          <div class="jfCard-question" style="max-height: 1197.68px; overflow-y: auto;">
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          <div class="jfCard-index">7</div>
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              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer"> Quel est votre degré général de satisfaction&nbsp;?</span><span class="jfRequiredStar">* <span
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                          <div class="jfRating-text" aria-hidden="true">1</div>
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                          <div class="jfRating-text" aria-hidden="true">2</div>
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                        /* #input_17_3:checked + .jfRating-svg-container, */
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                          color: #FCC658 !important;
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                      </style><input type="radio" class="jfRating-input form-radio validate[required]" name="q17_Quel" value="3" title="3" id="input_17_3" required="">
                      <div class="jfRating-svg-wrapper" style="color:#A7ABB1">
                        <div class="jfRating-svg-container"><svg class="jfRating-svg" width="66px" height="62px" viewBox="0 0 66 62" version="1.1" xmlns="http://www.w3.org/2000/svg">
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                          <div class="jfRating-text" aria-hidden="true">3</div>
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                    <li class="jfRating-item jfRating-selection  input_17_4" data-value="4" style="height:76px" role="presentation">
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                      <div class="jfRating-svg-wrapper" style="color:#A7ABB1">
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                          <div class="jfRating-text" aria-hidden="true">4</div>
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                    <li class="jfRating-item jfRating-selection  input_17_5" data-value="5" style="height:76px" role="presentation">
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                      </style><input type="radio" class="jfRating-input form-radio validate[required]" name="q17_Quel" value="5" title="5" id="input_17_5" required="">
                      <div class="jfRating-svg-wrapper" style="color:#A7ABB1">
                        <div class="jfRating-svg-container"><svg class="jfRating-svg" width="66px" height="62px" viewBox="0 0 66 62" version="1.1" xmlns="http://www.w3.org/2000/svg">
                            <g stroke="none" stroke-width="1" fill-rule="evenodd">
                              <g transform="translate(-61.000000, -162.000000)" fill="currentColor">
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                            </g>
                          </svg>
                          <div class="jfRating-text" aria-hidden="true">5</div>
                        </div>
                      </div>
                    </li>
                  </ul><input type="hidden" name="q17_stars" class="form-textbox" data-lowest="1">
                </div><label class="jfField-sublabel " for="input_17"></label>
              </div>
            </div>
          </div>
          <div class="jfCard-actions"><button style="display:block" type="button" class="jfInput-button forPrev u-left" data-component="button" aria-label="Précédent">Précédent</button><button style="display:block" type="button"
              class="jfInput-button forNext u-right" data-component="button" aria-label="suivant">suivant</button><button style="display:none" type="submit" class="jfInput-button forSubmit u-right" data-component="button"
              aria-label="Envoyer !">Envoyer !</button>
            <div class="cf">
              <div class="jfCard-actionsNotification" aria-live="polite">
                <div class="jfPressEnter isHidden" aria-hidden="true">Press<br>Enter</div>
              </div>
            </div>
            <div class="jfCard-disableSubmitError"></div>
          </div>
        </div>
      </div>
    </li>
    <li class="form-line" data-type="control_yesno" id="id_20">
      <div id="cid_20" class="jfCard-wrapper transition-all-015s" style="width: 940px; margin-left: 0px;">
        <div class="jfCard canMoveAuto" data-type="control_yesno" style="max-height: 1200px;">
          <div class="jfCard-index">8</div>
          <div class="jfCard-question" style="max-height: 1197.68px; overflow-y: auto;">
            <div class="jfQuestion-fullscreen isHidden" aria-hidden="true" role="button" aria-label="fullscreen mode" tabindex="-1"></div><label for="input_20" class="jfQuestion-label isCenterAlign" id="label_20"
              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer">Recommanderiez-vous notre clinique à vos proches ?</span><span class="jfRequiredStar">* <span
                  class="jfRequiredStar-message">This field is required.</span></span></label><span class="jfQuestion-description" id="input_20_description"><span></span></span>
            <div class="jfCard-mobileError jsMobileErrorWrapper"></div>
            <div class="jfQuestion-fields" data-wrapper-react="true">
              <div class="jfField" role="group" aria-labelledby="label_20"><label class="jfYesno" tabindex="0" role="radio" aria-checked="false"><input type="radio" class="jfYesno-input form-radio validate[required] jsToggle" value="OUI"
                    id="input_input_20_0" name="q20_recommanderiezvousNotre"><span class="jfYesno-label">OUI</span></label><label class="jfYesno" tabindex="0" role="radio" aria-checked="false"><input type="radio"
                    class="jfYesno-input form-radio validate[required] jsToggle" value="NON" id="input_input_20_1" name="q20_recommanderiezvousNotre"><span class="jfYesno-label">NON</span></label></div>
            </div>
          </div>
          <div class="jfCard-actions"><button style="display:block" type="button" class="jfInput-button forPrev u-left" data-component="button" aria-label="Précédent">Précédent</button><button style="display:block" type="button"
              class="jfInput-button forNext u-right" data-component="button" aria-label="suivant">suivant</button><button style="display:none" type="submit" class="jfInput-button forSubmit u-right" data-component="button"
              aria-label="Envoyer !">Envoyer !</button>
            <div class="cf">
              <div class="jfCard-actionsNotification" aria-live="polite">
                <div class="jfPressEnter isHidden" aria-hidden="true">Press<br>Enter</div>
              </div>
            </div>
            <div class="jfCard-disableSubmitError"></div>
          </div>
        </div>
      </div>
    </li>
    <li class="form-line always-hidden alwaysHidden " data-type="control_autoincrement" id="id_1">
      <div id="cid_1" class="jfCard-wrapper transition-all-015s" style="width: 940px; margin-left: 0px;">
        <div class="jfCard" data-type="control_autoincrement" style="max-height: 1200px;">
          <div class="jfCard-index">9</div>
          <div class="jfCard-question" data-widget-id="528c8b464b1a424916000004" style="max-height: 1200px; overflow-y: auto;">
            <div class="jfQuestion-fullscreen isHidden" aria-hidden="true" role="button" aria-label="fullscreen mode" tabindex="-1"></div><label for="input_1" class="jfQuestion-label isCenterAlign" id="label_1"
              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer">UniqueID</span></label><span class="jfQuestion-description" id="input_1_description"><span></span></span>
            <div class="jfCard-mobileError jsMobileErrorWrapper"></div>
            <div class="jfQuestion-fields">
              <div class="jfField isFilled" data-type="autoincrement"><input type="hidden" id="input_1" name="q1_UniqueID" class="form-hidden jfInput-input hasSublabel" value="180" data-component="autoincrement" aria-required="false"
                  aria-describedby="input_1_description"><label class="jfField-sublabel " for="input_1"></label></div>
            </div>
          </div>
          <div class="jfCard-actions"><button style="display:block" type="button" class="jfInput-button forPrev u-left" data-component="button" aria-label="Précédent">Précédent</button><button style="display:block" type="button"
              class="jfInput-button forNext u-right" data-component="button" aria-label="suivant">suivant</button><button style="display:none" type="submit" class="jfInput-button forSubmit u-right" data-component="button"
              aria-label="Envoyer !">Envoyer !</button>
            <div class="cf">
              <div class="jfCard-actionsNotification" aria-live="polite">
                <div class="jfPressEnter isHidden" aria-hidden="true">Press<br>Enter</div>
              </div>
            </div>
            <div class="jfCard-disableSubmitError"></div>
          </div>
        </div>
      </div>
    </li>
    <li class="form-line" data-type="control_textarea" id="id_18">
      <div id="cid_18" class="jfCard-wrapper transition-all-015s" style="width: 940px; margin-left: 0px;">
        <div class="jfCard" data-type="control_textarea" style="max-height: 1200px;">
          <div class="jfCard-index">9</div>
          <div class="jfCard-question" style="max-height: 1197.68px; overflow-y: auto;">
            <div class="jfQuestion-fullscreen" aria-hidden="true" role="button" aria-label="fullscreen mode" tabindex="-1"></div><label for="input_18" class="jfQuestion-label isCenterAlign" id="label_18"
              style="max-height: unset; overflow-y: unset;"><span class="jsQuestionLabelContainer jfQuestionLabelContainer">Commentaires &amp; Suggestions</span></label><span class="jfQuestion-description"
              id="input_18_description"><span></span></span>
            <div class="jfCard-mobileError jsMobileErrorWrapper"></div>
            <div class="jfQuestion-fields" data-component="textarea" data-render-type="mde">
              <div class="jfField"><textarea id="input_18" name="q18_commentaires" placeholder="" class="mdInput form-textarea"></textarea>
                <div id="input_18_editor" class="jfTextarea-editor" role="textbox" aria-multiline="true" contenteditable="true" data-placeholder=""></div>
                <div class="jfTextarea-infoSpan isHidden"><span class="jfTextarea-limitSpan"></span><span class="jfTextarea-modeSpan"></span></div>
              </div>
            </div>
          </div>
          <div class="jfToolbar" id="input_18_toolbar" role="toolbar" aria-label="Text Formatting">
            <div id="input_18_fontSize" data-command="heading" class="jfToolbar-item forBoth" tabindex="0" role="button" aria-label="Font Size" aria-controls="input_18_fontSize_menu" aria-expanded="false">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-fontSize "><svg viewBox="0 0 32 32" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>TextSize</title>
                    <desc>Created with Sketch.</desc>
                    <defs></defs>
                    <g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
                      <g fill="#4A4A4A">
                        <g transform="translate(3.000000, 6.000000)">
                          <g fill-rule="nonzero">
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                            <path d="M5.25,20.5 L13.25,20.5 C13.9403559,20.5 14.5,19.9403559 14.5,19.25 C14.5,18.5596441 13.9403559,18 13.25,18 L5.25,18 C4.55964406,18 4,18.5596441 4,19.25 C4,19.9403559 4.55964406,20.5 5.25,20.5 Z"></path>
                            <path d="M8,1.25 L8,19.25 C8,19.9403559 8.55964406,20.5 9.25,20.5 C9.94035594,20.5 10.5,19.9403559 10.5,19.25 L10.5,1.25 C10.5,0.559644063 9.94035594,0 9.25,0 C8.55964406,0 8,0.559644063 8,1.25 Z"></path>
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                          <g transform="translate(15.000000, 8.700000)">
                            <path
                              d="M1.4609612,1.70000076 L10.5189207,1.70000076 L10.5390388,2.45720466 C10.5390388,2.75698225 10.8660861,3 11.2695194,3 C11.6729527,3 12,2.75698225 12,2.45720466 L11.9798819,0.542795343 C11.9798819,0.243017753 11.6528346,0 11.2494013,0 L0.730480602,0 C0.327047306,0 0,0.243017753 0,0.542795343 L0.0201181228,2.45720466 C0.0201181228,2.75698225 0.347165428,3 0.750598725,3 C1.15403202,3 1.48107933,2.75698225 1.48107933,2.45720466 L1.4609612,1.70000076 Z"
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                            <path d="M5,1.6097561 L5,10.3902439 C5,10.7270029 5.44771525,11 6,11 C6.55228475,11 7,10.7270029 7,10.3902439 L7,1.6097561 C7,1.2729971 6.55228475,1 6,1 C5.44771525,1 5,1.2729971 5,1.6097561 Z" fill-rule="nonzero"></path>
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              <ul class="jfToolbar-select jfToolbar-select-heading" data-command="heading" role="menu" id="input_18_fontSize_menu">
                <li data-value="1" style="font-size:2em" data-selected="true" tabindex="0" role="menuitemradio" aria-checked="true">Huge</li>
                <li data-value="3" style="font-size:1.17em" data-selected="false" tabindex="0" role="menuitemradio" aria-checked="false">Large</li>
                <li data-value="5" style="font-size:0.83em" data-selected="false" tabindex="0" role="menuitemradio" aria-checked="false">Normal</li>
                <li data-value="6" style="font-size:0.67em" data-selected="false" tabindex="0" role="menuitemradio" aria-checked="false">Small</li>
              </ul>
            </div>
            <div id="input_18_bold" data-command="bold" class="jfToolbar-item breakBefore forBoth" tabindex="0" role="button" aria-label="Bold">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-bold "><svg viewBox="0 0 32 32" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>Bold</title>
                    <desc>Created with Sketch.</desc>
                    <defs></defs>
                    <g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
                      <g fill-rule="nonzero" fill="#4A4A4A">
                        <g transform="translate(9.000000, 6.000000)">
                          <path
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                          <path
                            d="M2.5,11.40625 L2.5,17.65625 L9.90384615,17.65625 C11.2992605,17.65625 12.5,16.2904088 12.5,14.53125 C12.5,12.7720912 11.2992605,11.40625 9.90384615,11.40625 L2.5,11.40625 Z M1.25,8.90625 L9.90384615,8.90625 C12.7567761,8.90625 15,11.4579172 15,14.53125 C15,17.6045828 12.7567761,20.15625 9.90384615,20.15625 L1.25,20.15625 C0.559644063,20.15625 0,19.5966059 0,18.90625 L0,10.15625 C0,9.46589406 0.559644063,8.90625 1.25,8.90625 Z">
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            </div>
            <div id="input_18_italic" data-command="italic" class="jfToolbar-item forBoth" tabindex="0" role="button" aria-label="Italic">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-italic "><svg viewBox="0 0 32 32" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>Italic</title>
                    <desc>Created with Sketch.</desc>
                    <defs></defs>
                    <g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
                      <g fill-rule="nonzero" fill="#4A4A4A">
                        <g transform="translate(9.000000, 6.000000)">
                          <path
                            d="M13.5882353,0 L4.94117647,0 C4.25894237,0 3.70588235,0.553060015 3.70588235,1.23529412 C3.70588235,1.91752822 4.25894237,2.47058824 4.94117647,2.47058824 L13.5882353,2.47058824 C14.2704694,2.47058824 14.8235294,1.91752822 14.8235294,1.23529412 C14.8235294,0.553060015 14.2704694,0 13.5882353,0 Z">
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                          <path
                            d="M9.88235294,17.2941176 L1.23529412,17.2941176 C0.553060015,17.2941176 0,17.8471777 0,18.5294118 C0,19.2116459 0.553060015,19.7647059 1.23529412,19.7647059 L9.88235294,19.7647059 C10.564587,19.7647059 11.1176471,19.2116459 11.1176471,18.5294118 C11.1176471,17.8471777 10.564587,17.2941176 9.88235294,17.2941176 Z">
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                          <path
                            d="M8.69458806,0.895932724 L3.75341159,18.1900504 C3.56598747,18.8460348 3.94583065,19.5297525 4.60181508,19.7171766 C5.2577995,19.9046008 5.94151722,19.5247576 6.12894135,18.8687732 L11.0701178,1.57465551 C11.2575419,0.918671083 10.8776988,0.234953363 10.2217143,0.0475292411 C9.56572991,-0.139894881 8.88201219,0.239948297 8.69458806,0.895932724 Z">
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                  </svg></span></div>
            </div>
            <div id="input_18_underline" data-command="underline" class="jfToolbar-item forBoth" tabindex="0" role="button" aria-label="Underline">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-underline "><svg viewBox="0 0 32 32" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>Underline</title>
                    <desc>Created with Sketch.</desc>
                    <defs></defs>
                    <g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
                      <g fill-rule="nonzero" fill="#4A4A4A">
                        <g transform="translate(7.000000, 5.000000)">
                          <path
                            d="M2.15909091,1.29545455 L2.15909091,8.27097902 C2.15909091,12.2813233 5.34161889,15.5454545 9.28409091,15.5454545 C13.2265629,15.5454545 16.4090909,12.2813233 16.4090909,8.27097902 L16.4090909,1.29545455 C16.4090909,0.579994756 15.8290962,0 15.1136364,0 C14.3981766,0 13.8181818,0.579994756 13.8181818,1.29545455 L13.8181818,8.27097902 C13.8181818,10.864879 11.780757,12.9545455 9.28409091,12.9545455 C6.78742483,12.9545455 4.75,10.864879 4.75,8.27097902 L4.75,1.29545455 C4.75,0.579994756 4.17000524,0 3.45454545,0 C2.73908566,0 2.15909091,0.579994756 2.15909091,1.29545455 Z">
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                          <path
                            d="M1.29545455,20.7272727 L16.8409091,20.7272727 C17.5563689,20.7272727 18.1363636,20.147278 18.1363636,19.4318182 C18.1363636,18.7163584 17.5563689,18.1363636 16.8409091,18.1363636 L1.29545455,18.1363636 C0.579994756,18.1363636 0,18.7163584 0,19.4318182 C0,20.147278 0.579994756,20.7272727 1.29545455,20.7272727 Z">
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                  </svg></span></div>
            </div>
            <div id="input_18_createLink" data-command="createLink" class="jfToolbar-item forBoth" tabindex="0" role="button" aria-label="Insert Link">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-createLink "><svg viewBox="0 0 32 32" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>Underline Copy</title>
                    <desc>Created with Sketch.</desc>
                    <defs></defs>
                    <g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
                      <g fill-rule="nonzero" fill="#4A4A4A">
                        <g transform="translate(6.000000, 6.000000)">
                          <path
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                          <path
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                  </svg></span></div>
              <div class="jfToolbar-modal forUrl"><input type="url" id="modalLinkUrl_input_18" class="jfModal-input jfModal-modalLinkUrl" data-disable-enter-event="true" data-disable-escape-event="true" placeholder="Enter URL"
                  aria-label="link url input">
                <div class="modal-btn" role="button" tabindex="0">Ok</div>
              </div>
            </div>
            <div id="input_18_ul" data-command="insertUnorderedList" class="jfToolbar-item breakBefore forBoth" tabindex="0" role="button" aria-label="Insert Bullet List">
              <div class="jfToolbar-icon"><span class="iconSvg  jftoolbar-ul "><svg viewBox="0 0 18 18" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
                    <title>NumberList Copy 2</title>
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Questionnaire Satisfaction Patients
Chère Madame, Cher Monsieur, Votre opinion compte beaucoup pour nous car elle
nous permettra d’améliorer notre service de manière continue. Toute l’équipe de
GENOLIER PATIENT SERVICES vous en remercie

Previous
Débuter

Language
 * Français
 * Russian
 * English (US)
 * Italiano
 * Deutsch

 * 1
   
   Dans quelle parmi ces cliniques séjournez-vous ?* This field is required.
   
   
   Clinique de Genolier
   
   Clinique de Montchoisi
   
   Clinica Sant' Anna
   
   Privatklinik Bethanien
   
   Privatklinik Lindberg
   
   Clinique Valmont
   
   Clinique Générale Beaulieu
   
   Nescens Clinique de Genolier
   PrécédentsuivantEnvoyer !
   Press
   Enter
   
 * 2
   
   Avant votre arrivée* This field is required.
   
   Comment jugez-vous votre premier contact avec notre clinique ? (amabilité de
   l’interlocuteur, efficacité et rapidité de réponse)
   Comment qualifiez-vous la qualité des informations obtenues ? (devis,
   programme médical et support à votre voyage)
   
   Comment jugez-vous votre premier contact avec notre clinique ? (amabilité de
   l’interlocuteur, efficacité et rapidité de réponse)
   Comment qualifiez-vous la qualité des informations obtenues ? (devis,
   programme médical et support à votre voyage)
   
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 3
   
   Pendant votre séjour* This field is required.
   
   Comment qualifiez-vous la qualité des soins infirmiers ?
   Comment évaluez-vous la qualité de la prise en charge médicale ? (fréquence
   des visites et disponibilité du médecin)
   Comment évaluez-vous la qualité de l’accompagnement par votre coordinatrice
   médicale personnelle ?
   Comment qualifiez-vous, de manière générale, la disponibilité et le
   professionnalisme des collaborateurs ?
   Comment jugez-vous la qualité des repas ?
   Comment qualifiez-vous le confort de la chambre?
   Comment jugez-vous le service de housekeeping (tenue de votre chambre) ?
   
   Comment qualifiez-vous la qualité des soins infirmiers ?
   Comment évaluez-vous la qualité de la prise en charge médicale ? (fréquence
   des visites et disponibilité du médecin)
   Comment évaluez-vous la qualité de l’accompagnement par votre coordinatrice
   médicale personnelle ?
   Comment qualifiez-vous, de manière générale, la disponibilité et le
   professionnalisme des collaborateurs ?
   Comment jugez-vous la qualité des repas ?
   Comment qualifiez-vous le confort de la chambre?
   Comment jugez-vous le service de housekeeping (tenue de votre chambre) ?
   
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 4
   
   Votre départ* This field is required.Comment avez-vous trouvé la durée de
   votre hospitalisation ?
   
   Trop courteAppropriéeTrop longue
   
    * 
    * Trop courte
    * Appropriée
    * Trop longue
   
   PrécédentsuivantEnvoyer !
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 * 5
   
   Votre départ* This field is required.
   
   Vous a-t-on expliqué de manière compréhensible à quoi servaient les
   médicaments à prendre une fois de retour chez vous ?
   Comment évaluez-vous l’organisation de votre sortie ?
   
   Vous a-t-on expliqué de manière compréhensible à quoi servaient les
   médicaments à prendre une fois de retour chez vous ?
   Comment évaluez-vous l’organisation de votre sortie ?
   
   
   PrécédentsuivantEnvoyer !
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 * 6
   
   Autres* This field is required.Comment avez-vous entendu parler de notre
   clinique?
   
   ConnaissanceMédecin traitantSite InternetVotre spécialisteAutreDéjà patient
   
    * 
    * Connaissance
    * Médecin traitant
    * Site Internet
    * Votre spécialiste
    * Autre
    * Déjà patient
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 7
   
   Quel est votre degré général de satisfaction ?* This field is required.
   
    * 1
    * 2
    * 3
    * 4
    * 5
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 8
   
   Recommanderiez-vous notre clinique à vos proches ?* This field is required.
   
   OUINON
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 9
   
   UniqueID
   
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 9
   
   Commentaires & Suggestions
   
   
   TextSizeCreated with Sketch.
    * Huge
    * Large
    * Normal
    * Small
   
   BoldCreated with Sketch.
   ItalicCreated with Sketch.
   UnderlineCreated with Sketch.
   Underline CopyCreated with Sketch.
   Ok
   NumberList Copy 2Created with Sketch.
   
   quoteCreated with Sketch.
   BreakCreated with Sketch.
   ImageCreated with Sketch.
   Ok
   SmileyCreated with Sketch.
    * 😁
    * 😡
    * 😂
    * 😉
    * 😊
    * 🙈
    * 😬
    * 😝
    * 😘
    * 💛
    * 😍
    * 😸
    * 👍
    * 😔
    * 😭
    * 💋
    * 😒
    * 😳
    * 😜
    * 😃
    * 😢
    * 😱
    * 😏
    * 😞
    * 😅
    * 😚
    * 🙊
    * 😌
    * 😀
    * 😝
   
   PrécédentsuivantEnvoyer !
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 * 10
   
   Souhaitez-vous être informé régulièrement sur nos activités ?
   
   OUINON
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 11
   
   Votre adresse mail
   
   exemple@exemple.com
   
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * 12
   
   Captcha* This field is required.
   
   
   PrécédentsuivantEnvoyer !
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   Enter
   
 * Should be Empty:



1. Dans quelle parmi ces cliniques séjournez-vous ?

2. Avant votre arrivée

3. Pendant votre séjour

4. Votre départ

5. Votre départ

6. Autres

7. Quel est votre degré général de satisfaction ?

8. Recommanderiez-vous notre clinique à vos proches ?

undefined

9. Commentaires & Suggestions

10. Souhaitez-vous être informé régulièrement sur nos activités ?

11. Votre adresse mail

12. Captcha
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