www.nest.sn
Open in
urlscan Pro
2001:4b98:dc6:253::16
Public Scan
Submitted URL: https://nest.sn/soutenir-notre-mission
Effective URL: https://www.nest.sn/soutenir-notre-mission
Submission: On November 21 via api from US — Scanned from FR
Effective URL: https://www.nest.sn/soutenir-notre-mission
Submission: On November 21 via api from US — Scanned from FR
Form analysis 2 forms found in the DOM
POST /soutenir-notre-mission/
<form id="wpforms-form-1488" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="1488" method="post" enctype="multipart/form-data" action="/soutenir-notre-mission/" data-token="647d0a9e6921b32ce9e2222af123d741"
novalidate="novalidate"><noscript class="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</noscript>
<div class="wpforms-hidden" id="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</div>
<div class="wpforms-field-container">
<div id="wpforms-1488-field_0-container" class="wpforms-field wpforms-field-name" data-field-id="0"><label class="wpforms-field-label" for="wpforms-1488-field_0">Votre nom <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-1488-field_0" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][0]" aria-errormessage="wpforms-1488-field_0-error" required=""></div>
<div id="wpforms-1488-field_11-container" class="wpforms-field wpforms-field-email" data-field-id="11"><label class="wpforms-field-label" for="wpforms-1488-field_11">Adresse de messagerie <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="email" id="wpforms-1488-field_11" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][11]" spellcheck="false" aria-errormessage="wpforms-1488-field_11-error" required="">
</div>
<div id="wpforms-1488-field_17-container" class="wpforms-field wpforms-field-date-time" data-field-id="17">
<fieldset>
<legend class="wpforms-field-label">Date de naissance</legend>
<div class="wpforms-field-date-dropdown-wrap wpforms-field-large"><select name="wpforms[fields][17][date][d]" id="wpforms-1488-field_17-day" class="wpforms-field-date-time-date-day" aria-label="Jour">
<option value="" class="placeholder" selected="" disabled="">JJ</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><select name="wpforms[fields][17][date][m]" id="wpforms-1488-field_17-month" class="wpforms-field-date-time-date-month" aria-label="Mois">
<option value="" class="placeholder" selected="" disabled="">MM</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><select name="wpforms[fields][17][date][y]" id="wpforms-1488-field_17-year" class="wpforms-field-date-time-date-year" aria-label="Année">
<option value="" class="placeholder" selected="" disabled="">AAAA</option>
<option value="2024">2024</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select></div>
</fieldset>
</div>
<div id="wpforms-1488-field_18-container" class="wpforms-field wpforms-field-name" data-field-id="18"><label class="wpforms-field-label" for="wpforms-1488-field_18">Médecin traitant <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-1488-field_18" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][18]" aria-errormessage="wpforms-1488-field_18-error" required=""></div>
<div id="wpforms-1488-field_9-container" class="wpforms-field wpforms-field-phone" data-field-id="9"><label class="wpforms-field-label" for="wpforms-1488-field_9">Téléphone <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="tel" id="wpforms-1488-field_9" class="wpforms-field-large wpforms-field-required" data-rule-int-phone-field="true" name="wpforms[fields][9]" aria-errormessage="wpforms-1488-field_9-error"
required=""></div>
<div id="wpforms-1488-field_13-container" class="wpforms-field wpforms-field-text" data-field-id="13"><label class="wpforms-field-label" for="wpforms-1488-field_13">Objet <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-1488-field_13" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][13]" aria-errormessage="wpforms-1488-field_13-error" required=""></div>
<div id="wpforms-1488-field_16-container" class="wpforms-field wpforms-field-textarea" data-field-id="16"><label class="wpforms-field-label" for="wpforms-1488-field_16">Votre message <span class="wpforms-required-label"
aria-hidden="true">*</span></label><textarea id="wpforms-1488-field_16" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][16]" aria-errormessage="wpforms-1488-field_16-error" required=""></textarea></div>
</div><!-- .wpforms-field-container -->
<div class="wpforms-recaptcha-container wpforms-is-recaptcha">
<div class="g-recaptcha" data-sitekey="6LeJK2gpAAAAAFfV8t2dpHem4MSCtCJhUljUt1UG" data-recaptcha-id="0">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-1r0t7f2s2btr" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LeJK2gpAAAAAFfV8t2dpHem4MSCtCJhUljUt1UG&co=aHR0cHM6Ly93d3cubmVzdC5zbjo0NDM.&hl=fr&v=-ZG7BC9TxCVEbzIO2m429usb&size=normal&cb=rnddtvjy9dbt"></iframe></div>
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div>
</div><input type="text" name="g-recaptcha-hidden" class="wpforms-recaptcha-hidden"
style="position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;" data-rule-recaptcha="1">
</div>
<div class="wpforms-submit-container"><input type="hidden" name="wpforms[id]" value="1488"><input type="hidden" name="wpforms[author]" value="1"><input type="hidden" name="wpforms[post_id]" value="909"><button type="submit" name="wpforms[submit]"
id="wpforms-submit-1488" class="wpforms-submit" data-alt-text="Envoi..." data-submit-text="Envoyer" aria-live="assertive" value="wpforms-submit">Envoyer</button><img
src="https://www.nest.sn/wp-content/plugins/wpforms/assets/images/submit-spin.svg" class="wpforms-submit-spinner" style="display: none;" width="26" height="26" alt="Chargement en cours"></div>
</form>POST /soutenir-notre-mission/
<form id="wpforms-form-1332" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="1332" method="post" enctype="multipart/form-data" action="/soutenir-notre-mission/" data-token="acc4dddf7b543b037b1126e0e891e2a5"
novalidate="novalidate"><noscript class="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</noscript>
<div class="wpforms-hidden" id="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</div>
<div class="wpforms-field-container">
<div id="wpforms-1332-field_19-container" class="wpforms-field wpforms-field-html" data-field-id="19">
<div id="wpforms-1332-field_19" aria-errormessage="wpforms-1332-field_19-error">
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
<script src="https://code.jquery.com/jquery-1.12.4.js"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script>
$(function() {
$("#wpforms-form-1332").submit(function(e) {
e.preventDefault();
var formData = getFormData($(this));
var apiData = mapFormData(formData);
$.ajax({
method: "POST",
url: "https://www.nestcrm.net/api/web/app_dev.php/prospectrendezvous",
data: apiData,
success: function(response) {
console.log(response);
// Traitez la réponse de l'API ici
},
error: function(xhr, status, error) {
console.error(xhr.responseText);
// Gérez les erreurs ici
}
});
});
function getFormData($form) {
var datas = {};
$form.find("input, select, textarea").each(function() {
datas[$(this).attr("name")] = $(this).val();
});
return datas;
}
function mapFormData(formData) {
// Récupérer la valeur sélectionnée du champ "typeConsultation"
var typeConsultation = $('input[name="wpforms[fields][7]"]:checked').val();
return {
nom: formData['wpforms[fields][0]'],
prenom: formData['wpforms[fields][8]'],
telephone: formData['wpforms[fields][9]'],
dateRendezVous: formData['dateRendezVous'],
dateNaissance: formData['wpforms[fields][13][date][y]'] + '-' + formData['wpforms[fields][13][date][m]'] + '-' + formData['wpforms[fields][13][date][d]'],
heure: formData['heure'],
nomMedecin: formData['wpforms[fields][12]'], // Remplacez '12' par le bon index pour le champ nomMedecin
typeConsultation: typeConsultation, // Remplacez '7' par le bon index pour le champ typeConsultation
'g-recaptcha-response': formData['g-recaptcha-response'] // Ajoutez le jeton reCAPTCHA
};
}
});
</script>
</div>
</div>
<div id="wpforms-1332-field_0-container" class="wpforms-field wpforms-field-name" data-field-id="0"><label class="wpforms-field-label" for="wpforms-1332-field_0">Votre nom <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-1332-field_0" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][0]" aria-errormessage="wpforms-1332-field_0-error" required=""></div>
<div id="wpforms-1332-field_8-container" class="wpforms-field wpforms-field-name" data-field-id="8"><label class="wpforms-field-label" for="wpforms-1332-field_8">Votre prénom <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-1332-field_8" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][8]" aria-errormessage="wpforms-1332-field_8-error" required=""></div>
<div id="wpforms-1332-field_13-container" class="wpforms-field wpforms-field-date-time" data-field-id="13">
<fieldset>
<legend class="wpforms-field-label">Votre date de naissance <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<div class="wpforms-field-date-dropdown-wrap wpforms-field-large"><select name="wpforms[fields][13][date][d]" id="wpforms-1332-field_13-day" class="wpforms-field-date-time-date-day wpforms-field-required" aria-label="Jour" required="">
<option value="" class="placeholder" selected="" disabled="">JJ</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><select name="wpforms[fields][13][date][m]" id="wpforms-1332-field_13-month" class="wpforms-field-date-time-date-month wpforms-field-required" aria-label="Mois" required="">
<option value="" class="placeholder" selected="" disabled="">MM</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><select name="wpforms[fields][13][date][y]" id="wpforms-1332-field_13-year" class="wpforms-field-date-time-date-year wpforms-field-required" aria-label="Année" required="">
<option value="" class="placeholder" selected="" disabled="">AAAA</option>
<option value="2024">2024</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select></div>
</fieldset>
</div>
<div id="wpforms-1332-field_9-container" class="wpforms-field wpforms-field-phone" data-field-id="9"><label class="wpforms-field-label" for="wpforms-1332-field_9">Téléphone <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="tel" id="wpforms-1332-field_9" class="wpforms-field-large wpforms-field-required" data-rule-int-phone-field="true" name="wpforms[fields][9]" aria-errormessage="wpforms-1332-field_9-error"
required=""></div>
<div id="wpforms-1332-field_7-container" class="wpforms-field wpforms-field-radio consult wpforms-list-3-columns" data-field-id="7">
<fieldset>
<legend class="wpforms-field-label">Choisissez votre type de consultation <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-1332-field_7" class="wpforms-field-required wpforms-image-choices wpforms-image-choices-modern">
<li class="choice-1 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_1" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Pediatrie.svg" alt="Pédiatrie" title="Pédiatrie"></span><input type="radio" id="wpforms-1332-field_7_1" class="wpforms-screen-reader-element" name="wpforms[fields][7]"
value="Pédiatrie" aria-errormessage="wpforms-1332-field_7_1-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Pédiatrie</span></label></li>
<li class="choice-2 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_2" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Gynecologie-Obstetrique.svg" alt="Gynécologie" title="Gynécologie"></span><input type="radio" id="wpforms-1332-field_7_2" class="wpforms-screen-reader-element"
name="wpforms[fields][7]" value="Gynécologie" aria-errormessage="wpforms-1332-field_7_2-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Gynécologie</span></label></li>
<li class="choice-3 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_3" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Sage-femme.svg" alt="Sage-femme" title="Sage-femme"></span><input type="radio" id="wpforms-1332-field_7_3" class="wpforms-screen-reader-element" name="wpforms[fields][7]"
value="Sage-femme" aria-errormessage="wpforms-1332-field_7_3-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Sage-femme</span></label></li>
<li class="choice-4 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_4" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Ophtalmologie.svg" alt="Ophtalmologie" title="Ophtalmologie"></span><input type="radio" id="wpforms-1332-field_7_4" class="wpforms-screen-reader-element" name="wpforms[fields][7]"
value="Ophtalmologie" aria-errormessage="wpforms-1332-field_7_4-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Ophtalmologie</span></label></li>
<li class="choice-5 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_5" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Medecine-Generale.svg" alt="Médecine Générale" title="Médecine Générale"></span><input type="radio" id="wpforms-1332-field_7_5" class="wpforms-screen-reader-element"
name="wpforms[fields][7]" value="Médecine Générale" aria-errormessage="wpforms-1332-field_7_5-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Médecine Générale</span></label></li>
<li class="choice-6 depth-1 wpforms-image-choices-item"><label class="wpforms-field-label-inline" for="wpforms-1332-field_7_6" tabindex="0"><span class="wpforms-image-choices-image"><img
src="https://www.nest.sn/wp-content/uploads/2023/10/Infirmerie.svg" alt="Autre type de consultation" title="Autre type de consultation"></span><input type="radio" id="wpforms-1332-field_7_6" class="wpforms-screen-reader-element"
name="wpforms[fields][7]" value="Autre type de consultation" aria-errormessage="wpforms-1332-field_7_6-error" tabindex="-1" required=""><span class="wpforms-image-choices-label">Autre type de consultation</span></label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-1332-field_12-container" class="wpforms-field wpforms-field-text" data-field-id="12"><label class="wpforms-field-label" for="wpforms-1332-field_12">Avez-vous une préférence de praticien ?, si oui précisez son nom :</label><input
type="text" id="wpforms-1332-field_12" class="wpforms-field-large" name="wpforms[fields][12]" aria-errormessage="wpforms-1332-field_12-error"></div>
<div id="wpforms-1332-field_18-container" class="wpforms-field wpforms-field-html" data-field-id="18">
<div id="wpforms-1332-field_18" aria-errormessage="wpforms-1332-field_18-error"><label class="wpforms-field-label dhrdv" for="wpforms-1332-field_12">Date et heure du rendez-vous souhaitée</label></div>
</div>
<div id="wpforms-1332-field_15-container" class="wpforms-field wpforms-field-layout" data-field-id="15"><label class="wpforms-field-label wpforms-label-hide" for="wpforms-1332-field_15" aria-hidden="false">Date et heure du rendez-vous
souhaitée</label>
<div class="wpforms-field-layout-columns wpforms-field-layout-preset-50-50">
<div class="wpforms-layout-column wpforms-layout-column-50">
<div id="wpforms-1332-field_36-container" class="wpforms-field wpforms-field-html" data-field-id="36">
<div id="wpforms-1332-field_36" aria-errormessage="wpforms-1332-field_36-error"><label class="wpforms-field-label" for="wpforms-1332-field_36">Date <span class="wpforms-required-label" aria-hidden="true">*</span></label>
<input id="datepicker1" class="form-control drdv" name="dateRendezVous" required="" type="date" placeholder="" min="2024-11-21">
<script>
document.getElementById('datepicker1').min = new Date().toISOString().split('T')[0];
</script>
</div>
</div>
</div>
<div class="wpforms-layout-column wpforms-layout-column-50">
<div id="wpforms-1332-field_39-container" class="wpforms-field wpforms-field-html" data-field-id="39">
<div id="wpforms-1332-field_39" aria-errormessage="wpforms-1332-field_39-error"><label class="wpforms-field-label" for="wpforms-1332-field_39">Heure <span class="wpforms-required-label" aria-hidden="true">*</span></label>
<input id="heure" class="form-control hrdv" name="heure" required="" type="time" placeholder="Heure souhaitée">
</div>
</div>
</div>
</div>
</div>
</div><!-- .wpforms-field-container -->
<div class="wpforms-recaptcha-container wpforms-is-recaptcha">
<div class="g-recaptcha" data-sitekey="6LeJK2gpAAAAAFfV8t2dpHem4MSCtCJhUljUt1UG" data-recaptcha-id="1">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-sjyb12pxbvep" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LeJK2gpAAAAAFfV8t2dpHem4MSCtCJhUljUt1UG&co=aHR0cHM6Ly93d3cubmVzdC5zbjo0NDM.&hl=fr&v=-ZG7BC9TxCVEbzIO2m429usb&size=normal&cb=us0zli1myaoq"></iframe></div>
<textarea id="g-recaptcha-response-1" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div><input type="text" name="g-recaptcha-hidden" class="wpforms-recaptcha-hidden"
style="position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;" data-rule-recaptcha="1">
</div>
<div class="wpforms-submit-container"><input type="hidden" name="wpforms[id]" value="1332"><input type="hidden" name="wpforms[author]" value="1"><input type="hidden" name="wpforms[post_id]" value="909"><button type="submit" name="wpforms[submit]"
id="wpforms-submit-1332" class="wpforms-submit" data-alt-text="Envoi..." data-submit-text="Prendre rendez-vous" aria-live="assertive" value="wpforms-submit">Prendre rendez-vous</button><img
src="https://www.nest.sn/wp-content/plugins/wpforms/assets/images/submit-spin.svg" class="wpforms-submit-spinner" style="display: none;" width="26" height="26" alt="Chargement en cours"></div>
</form>Text Content
nest | Réseau Médical (+221) 33 835 28 00 Demander un devis Prendre rendez-vous (+221) 33 835 28 00 * Accueil * Services * Qui sommes-nous ? * A propos de Nest * Nos valeurs * Nos structures * Partenaires * Accueil * Services * Qui sommes-nous ? * A propos de Nest * Nos valeurs * Nos structures * Partenaires * S’engager * Soutenir notre mission * Intégrer le réseau nest * Actualités * Contacts * S’engager * Soutenir notre mission * Intégrer le réseau nest * Actualités * Contacts * Accueil * Services * A propos de NEST * Qui sommes-nous ? * Nos structures * Partenaires * S’engager * Intégrer le réseau nest * Soutenir notre mission * Actualités * Contacts Menu * Accueil * Services * A propos de NEST * Qui sommes-nous ? * Nos structures * Partenaires * S’engager * Intégrer le réseau nest * Soutenir notre mission * Actualités * Contacts * Accueil * Services * A propos de NEST * Qui sommes-nous ? * Nos structures * Partenaires * S’engager * Intégrer le réseau nest * Soutenir notre mission * Actualités * Contacts Menu * Accueil * Services * A propos de NEST * Qui sommes-nous ? * Nos structures * Partenaires * S’engager * Intégrer le réseau nest * Soutenir notre mission * Actualités * Contacts DEMANDER UN DEVIS PRENDRE RDV SOUTENIR NOTRE MISSION SOUTENIR NOTRE MISSION Permettre l’accès aux soins de qualité sur le territoire national et dans l’Afrique de l’Ouest est un enjeu majeur de notre société et mobilise de nombreux acteurs. Vous êtes un particulier, une entreprise ou une institution et vous souhaitez œuvrer en faveur de cette noble cause qu’est la santé pour tous ? C’est possible…en investissant pour soutenir le développement du réseau médical nest ou en rejoignant notre groupe de sympathisants ! Linkedin-in Instagram Facebook-f Youtube * Services * Qui sommes-nous ? * Partenaires * Contacts * Intégrer le réseau nest * Soutenir notre mission * Actualités nest Plateau Médical 546, Hlm Grand Médine, Dakar nest Clinique Liberté 6 Extension (VDN nord), Dakar Linkedin-in Instagram Facebook-f Youtube DEMANDER UN DEVIS Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. Votre nom * Adresse de messagerie * Date de naissance JJ12345678910111213141516171819202122232425262728293031MM123456789101112AAAA202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Médecin traitant * Téléphone * Objet * Votre message * Envoyer DEMANDE DE RENDEZ-VOUS Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. Votre nom * Votre prénom * Votre date de naissance * JJ12345678910111213141516171819202122232425262728293031MM123456789101112AAAA202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Téléphone * Choisissez votre type de consultation * * Pédiatrie * Gynécologie * Sage-femme * Ophtalmologie * Médecine Générale * Autre type de consultation Avez-vous une préférence de praticien ?, si oui précisez son nom : Date et heure du rendez-vous souhaitée Date et heure du rendez-vous souhaitée Date * Heure * Prendre rendez-vous Nous contacter ! WhatsApp Chat Messenger Chat Appel