{"id":33,"date":"2020-11-18T21:14:26","date_gmt":"2020-11-18T21:14:26","guid":{"rendered":"https:\/\/www.uqac.ca\/cup\/?page_id=33"},"modified":"2020-11-20T18:22:13","modified_gmt":"2020-11-20T18:22:13","slug":"paiement-en-ligne","status":"publish","type":"page","link":"https:\/\/www.uqac.ca\/cup\/paiement-en-ligne\/","title":{"rendered":"Formulaire de paiement"},"content":{"rendered":"<h2 style=\"text-align: center;\">Formulaire de paiement<\/h2>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_2_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_vp11ve\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">Formulaire de paiement<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"2\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_2\" id=\"frm_hide_fields_2\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"vp11ve\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_2\" name=\"frm_submit_entry_2\" value=\"912e13ab42\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/cup\/wp-json\/wp\/v2\/pages\/33\" \/><div id=\"frm_field_6_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_nwubdi\" class=\"frm_primary_label\">Num\u00e9ro de dossier\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nwubdi\" name=\"item_meta[6]\" value=\"\"  data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" aria-required=\"true\" data-invmsg=\"Num\u00e9ro de dossier est non valide\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7_container\" class=\"frm_form_field form-field  frm_top_container frm_full\">\r\n    <label for=\"field_w4bbu0\" class=\"frm_primary_label\">Adresse courriel\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_w4bbu0\" name=\"item_meta[7]\" value=\"cup@uqac.ca\"  readonly=\"readonly\"  data-frmval=\"cup@uqac.ca\" data-invmsg=\"Adresse courriel est non valide\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_eatgm\" id=\"field_eatgm_label\" class=\"frm_primary_label\">Date du rendez-vous (mm\/jj\/aaaa)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eatgm\" name=\"item_meta[12]\" value=\"\"  maxlength=\"20\" data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" aria-required=\"true\" data-invmsg=\"Date est non valide\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_8_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>Veuillez s\u00e9lectionner le type de service que vous souhaitez obtenir \u00e0 la Clinique universitaire de psychologie :<\/h5>\n<\/div>\n<div id=\"frm_field_9_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Type de consultation et autres frais\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_9-0\">\t\t\t<label  for=\"field_t5wwn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-0\" value=\"Seance individuelle en psychologie 30\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> S\u00e9ance individuelle en psychologie (30 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-1\">\t\t\t<label  for=\"field_t5wwn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-1\" value=\"Seance individuelle en psychologie 40\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> S\u00e9ance individuelle en psychologie (40 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-2\">\t\t\t<label  for=\"field_t5wwn-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-2\" value=\"annulation psy 15\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> Frais d\u2019annulation\/administratif psychologie (15 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-3\">\t\t\t<label  for=\"field_t5wwn-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-3\" value=\"annulation psy 20\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> Frais d\u2019annulation\/administratif psychologie (20 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-4\">\t\t\t<label  for=\"field_t5wwn-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-4\" value=\"Eval avec test - Paiement complet 600\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> \u00c9valuation avec test - Paiement complet (600 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-5\">\t\t\t<label  for=\"field_t5wwn-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-5\" value=\"Eval avec test - 1er paiement 300\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> \u00c9valuation avec test - 1er paiement (300 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-6\">\t\t\t<label  for=\"field_t5wwn-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-6\" value=\"Eval avec test - 2e paiement 300\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> \u00c9valuation avec test - 2e paiement (300 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-7\">\t\t\t<label  for=\"field_t5wwn-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-7\" value=\"annulation neuropsy 30\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> Frais d\u2019annulation\/administratif  neuropsychologie (30 $)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_9-8\">\t\t\t<label  for=\"field_t5wwn-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[9]\" id=\"field_t5wwn-8\" value=\"Intervention neuropsychologique 30\"\n\t\t data-reqmsg=\"Ce champ ne peut pas \u00eatre vide\" data-invmsg=\"Type de consultation et autres frais is invalid\"   \/> Intervention neuropsychologique (30 $)<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n    <label for=\"field_6zdu1q\" class=\"frm_primary_label\">Total (non taxable)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6zdu1q\" name=\"item_meta[10]\" value=\"\"  readonly=\"readonly\"  data-invmsg=\"Total (non taxable) est non valide\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n\t\t<input  type=\"hidden\" name=\"item_meta[11]\" id=\"field_9jku8t-0\" value=\"non\"  data-frmval=\"non\"   \/>\n\t\t<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_none_container\"><div  id=\"field_20xya\" class=\"frm-g-recaptcha\" data-sitekey=\"6LeiYc8pAAAAAJJNICd-KUG9DAP0gdRTIfPhSxZV\" data-size=\"invisible\" data-theme=\"light\"><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<div  id=\"field_hgbro_label\" class=\"frm_primary_label\">Product\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_data_container\" aria-labelledby=\"field_hgbro_label\" role=\"group\"><select name=\"item_meta[33]\" id=\"field_hgbro\"  data-invmsg=\"Product is invalid\" aria-invalid=\"false\"  >\n<option  value=\"\" data-frmprice=\"\" selected='selected'> <\/option><option  value=\"Product 1\" data-frmprice=\"\">Product 1<\/option><\/select>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<input type=\"submit\" value=\"Soumettre\"  class=\"frm_final_submit\" formnovalidate=\"formnovalidate\" \/>\r\n<img decoding=\"async\" class=\"frm_ajax_loading\" src=\"https:\/\/www.uqac.ca\/cup\/wp-content\/plugins\/formidable\/images\/ajax_loader.gif\" alt=\"Envoi\"\/>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_34_container\">\n\t\t\t<label for=\"field_ijifh\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_ijifh\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[34]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"8FkHVZUKf+MYHtUBtNFXAyUgeMjExNRyPw\/KfrP4qIGmrApydj9wg3ky0o\/DA1wP\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Formulaire de paiement<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"domaine":[],"class_list":["post-33","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/pages\/33","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/comments?post=33"}],"version-history":[{"count":9,"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/pages\/33\/revisions"}],"predecessor-version":[{"id":42,"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/pages\/33\/revisions\/42"}],"wp:attachment":[{"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/media?parent=33"}],"wp:term":[{"taxonomy":"domaine","embeddable":true,"href":"https:\/\/www.uqac.ca\/cup\/wp-json\/wp\/v2\/domaine?post=33"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}