{"id":7613,"date":"2021-03-17T16:57:16","date_gmt":"2021-03-17T15:57:16","guid":{"rendered":"https:\/\/equilli.com\/?page_id=7613"},"modified":"2021-03-17T17:06:29","modified_gmt":"2021-03-17T16:06:29","slug":"equilli-opvolging-slaapcontract-0","status":"publish","type":"page","link":"https:\/\/equilli.com\/fr\/equilli-opvolging-slaapcontract-0\/","title":{"rendered":"Equilli opvolging Slaapcontract 0"},"content":{"rendered":"<div class=\"wpb-content-wrapper\" id=\"wpb-content-root\"><p>[vc_row full_width=\u00a0\u00bbstretch_row\u00a0\u00bb][vc_column][vc_single_image image=\u00a0\u00bb3099&Prime; img_size=\u00a0\u00bbfull\u00a0\u00bb alignment=\u00a0\u00bbcenter\u00a0\u00bb]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_19' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/fr\/wp-json\/wp\/v2\/pages\/7613' data-formid='19' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcNo4QpAAAAAGxiudBj-1yXtW6wanOsKUKK8BgF' data-tabindex='0'><input id=\"input_e828e2aa5b5386a11afe61d387977d59\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e828e2aa5b5386a11afe61d387977d59\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_19_46\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_46'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_46' id='input_19_46' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_19_46'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_19_38\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_38' id='input_19_38' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/app-3QNND20RAY.marketingautomation.services\/webforms\/receivePostback\/MzawMLEwNjE1BQA\/' \/><\/div><\/li><li id=\"field_19_37\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_37' id='input_19_37' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='98ffbf0e-b22b-4c44-b924-2183bc2966b2' \/><\/div><\/li><li id=\"field_19_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>1. Dans quelle position de sommeil dormiez-vous principalement sur votre ancien matelas?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_39'><li class='gchoice gchoice_19_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='Sur le dos'  id='choice_19_39_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_39_1' id='label_19_39_1' class='gform-field-label gform-field-label--type-inline'>Sur le dos<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='Sur le c\u00f4t\u00e9'  id='choice_19_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_39_2' id='label_19_39_2' class='gform-field-label gform-field-label--type-inline'>Sur le c\u00f4t\u00e9<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='Sur le ventre'  id='choice_19_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_39_3' id='label_19_39_3' class='gform-field-label gform-field-label--type-inline'>Sur le ventre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_2\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>2. Quel changement remarquez-vous dans votre position de sommeil habituelle par rapport au matelas pr\u00e9c\u00e9dent?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_2'>\n\t\t\t<li class='gchoice gchoice_19_2_0'>\n\t\t\t\t<input name='input_2' type='radio' value='Pas de changement'  id='choice_19_2_0'    \/>\n\t\t\t\t<label for='choice_19_2_0' id='label_19_2_0' class='gform-field-label gform-field-label--type-inline'>Pas de changement<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_2_1'>\n\t\t\t\t<input name='input_2' type='radio' value='Je dors plus sur le c\u00f4t\u00e9'  id='choice_19_2_1'    \/>\n\t\t\t\t<label for='choice_19_2_1' id='label_19_2_1' class='gform-field-label gform-field-label--type-inline'>Je dors plus sur le c\u00f4t\u00e9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_2_2'>\n\t\t\t\t<input name='input_2' type='radio' value='Je dors plus sur le dos'  id='choice_19_2_2'    \/>\n\t\t\t\t<label for='choice_19_2_2' id='label_19_2_2' class='gform-field-label gform-field-label--type-inline'>Je dors plus sur le dos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_2_3'>\n\t\t\t\t<input name='input_2' type='radio' value='Je dors plus sur le ventre'  id='choice_19_2_3'    \/>\n\t\t\t\t<label for='choice_19_2_3' id='label_19_2_3' class='gform-field-label gform-field-label--type-inline'>Je dors plus sur le ventre<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>3. Dans quelle(s) position(s) de sommeil dormez-vous principalement sur votre nouveau matelas?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_40'><li class='gchoice gchoice_19_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Sur le dos'  id='choice_19_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_40_1' id='label_19_40_1' class='gform-field-label gform-field-label--type-inline'>Sur le dos<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Sur le c\u00f4t\u00e9'  id='choice_19_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_40_2' id='label_19_40_2' class='gform-field-label gform-field-label--type-inline'>Sur le c\u00f4t\u00e9<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='Sur le ventre'  id='choice_19_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_40_3' id='label_19_40_3' class='gform-field-label gform-field-label--type-inline'>Sur le ventre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_5\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_5'><span class='gform-field-label__text'>4. Comment \u00e9valuez-vous la qualit\u00e9 de votre sommeil sur l&#039;ancien matelas en lui attribuant une note sur 10?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_19_5' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisissez votre score' selected='selected'>Choisissez votre score<\/option><option value='10 - extr\u00eamement bon' >10 - extr\u00eamement bon<\/option><option value='9' >9<\/option><option value='8' >8<\/option><option value='7' >7<\/option><option value='6' >6<\/option><option value='5' >5<\/option><option value='4' >4<\/option><option value='3' >3<\/option><option value='2' >2<\/option><option value='1 - extr\u00eamement mauvais' >1 - extr\u00eamement mauvais<\/option><\/select><\/div><\/li><li id=\"field_19_6\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_6'><span class='gform-field-label__text'>5. Comment \u00e9valuez-vous la qualit\u00e9 de votre sommeil sur le nouveau matelas en lui attribuant une note sur 10?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_19_6' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisissez votre score' selected='selected'>Choisissez votre score<\/option><option value='10 - extr\u00eamement bon' >10 - extr\u00eamement bon<\/option><option value='9' >9<\/option><option value='8' >8<\/option><option value='7' >7<\/option><option value='6' >6<\/option><option value='5' >5<\/option><option value='4' >4<\/option><option value='3' >3<\/option><option value='2' >2<\/option><option value='1 - extr\u00eamement mauvais' >1 - extr\u00eamement mauvais<\/option><\/select><\/div><\/li><li id=\"field_19_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>6. Transpirez-vous plus ou moins par rapport \u00e0 votre ancien matelas?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_7'>\n\t\t\t<li class='gchoice gchoice_19_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Plus de transpiration'  id='choice_19_7_0'    \/>\n\t\t\t\t<label for='choice_19_7_0' id='label_19_7_0' class='gform-field-label gform-field-label--type-inline'>Plus de transpiration<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='Moins de transpiration'  id='choice_19_7_1'    \/>\n\t\t\t\t<label for='choice_19_7_1' id='label_19_7_1' class='gform-field-label gform-field-label--type-inline'>Moins de transpiration<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_7_2'>\n\t\t\t\t<input name='input_7' type='radio' value='Peu ou pas de changement car je ne transpire presque pas'  id='choice_19_7_2'    \/>\n\t\t\t\t<label for='choice_19_7_2' id='label_19_7_2' class='gform-field-label gform-field-label--type-inline'>Peu ou pas de changement car je ne transpire presque pas<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_7_3'>\n\t\t\t\t<input name='input_7' type='radio' value='Peu ou pas de changement car je transpire toujours beaucoup'  id='choice_19_7_3'    \/>\n\t\t\t\t<label for='choice_19_7_3' id='label_19_7_3' class='gform-field-label gform-field-label--type-inline'>Peu ou pas de changement car je transpire toujours beaucoup<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>7. Aviez-vous des troubles du sommeil avec votre ancien matelas? Si oui, lesquels?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_8'><li class='gchoice gchoice_19_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Aucun'  id='choice_19_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_1' id='label_19_8_1' class='gform-field-label gform-field-label--type-inline'>Aucun<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='Douleurs\/raideur dans le cou (au lever)'  id='choice_19_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_2' id='label_19_8_2' class='gform-field-label gform-field-label--type-inline'>Douleurs\/raideur dans le cou (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Douleurs\/raideur aux \u00e9paules (au lever)'  id='choice_19_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_3' id='label_19_8_3' class='gform-field-label gform-field-label--type-inline'>Douleurs\/raideur aux \u00e9paules (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_8_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.4' type='checkbox'  value='Douleurs dans le bas du dos (au lever)'  id='choice_19_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_4' id='label_19_8_4' class='gform-field-label gform-field-label--type-inline'>Douleurs dans le bas du dos (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_8_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.5' type='checkbox'  value='Douleurs au bassin (au lever)'  id='choice_19_8_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_5' id='label_19_8_5' class='gform-field-label gform-field-label--type-inline'>Douleurs au bassin (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_8_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.6' type='checkbox'  value='Autre'  id='choice_19_8_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_8_6' id='label_19_8_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_9\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_9'><span class='gform-field-label__text'>Si autre, quels troubles aviez-vous?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_19_9' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>8. Avez-vous des troubles du sommeil avec votre nouveau matelas ? Si oui, lesquels?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_10'><li class='gchoice gchoice_19_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Aucun'  id='choice_19_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_1' id='label_19_10_1' class='gform-field-label gform-field-label--type-inline'>Aucun<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Douleurs\/raideur dans le cou (au lever)'  id='choice_19_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_2' id='label_19_10_2' class='gform-field-label gform-field-label--type-inline'>Douleurs\/raideur dans le cou (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Douleurs\/raideur aux \u00e9paules (au lever)'  id='choice_19_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_3' id='label_19_10_3' class='gform-field-label gform-field-label--type-inline'>Douleurs\/raideur aux \u00e9paules (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Douleurs dans le bas du dos (au lever)'  id='choice_19_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_4' id='label_19_10_4' class='gform-field-label gform-field-label--type-inline'>Douleurs dans le bas du dos (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Douleurs au bassin (au lever)'  id='choice_19_10_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_5' id='label_19_10_5' class='gform-field-label gform-field-label--type-inline'>Douleurs au bassin (au lever)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Autre'  id='choice_19_10_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_10_6' id='label_19_10_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_11\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_11'><span class='gform-field-label__text'>Si autre, quels troubles avez-vous?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_19_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>9. Aviez-vous auparavant des douleurs pendant la journ\u00e9e (avec votre ancien matelas)? Si oui, lesquelles?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_12'><li class='gchoice gchoice_19_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='Aucune douleur'  id='choice_19_12_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_1' id='label_19_12_1' class='gform-field-label gform-field-label--type-inline'>Aucune douleur<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Douleurs au cou'  id='choice_19_12_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_2' id='label_19_12_2' class='gform-field-label gform-field-label--type-inline'>Douleurs au cou<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='Douleurs aux \u00e9paules'  id='choice_19_12_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_3' id='label_19_12_3' class='gform-field-label gform-field-label--type-inline'>Douleurs aux \u00e9paules<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_12_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.4' type='checkbox'  value='Douleurs dans le bas du dos'  id='choice_19_12_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_4' id='label_19_12_4' class='gform-field-label gform-field-label--type-inline'>Douleurs dans le bas du dos<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_12_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.5' type='checkbox'  value='Douleurs au bassin'  id='choice_19_12_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_5' id='label_19_12_5' class='gform-field-label gform-field-label--type-inline'>Douleurs au bassin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_12_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.6' type='checkbox'  value='Autre'  id='choice_19_12_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_12_6' id='label_19_12_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_13\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_13'><span class='gform-field-label__text'>Si autre, quels douleurs aviez-vous?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_19_13' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>10.  Avez-vous des douleurs pendant la journ\u00e9e avec votre matelas actuel? Si oui, lesquelles?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_14'><li class='gchoice gchoice_19_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Aucune douleur'  id='choice_19_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_1' id='label_19_14_1' class='gform-field-label gform-field-label--type-inline'>Aucune douleur<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='Douleurs au cou'  id='choice_19_14_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_2' id='label_19_14_2' class='gform-field-label gform-field-label--type-inline'>Douleurs au cou<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='Douleurs aux \u00e9paules'  id='choice_19_14_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_3' id='label_19_14_3' class='gform-field-label gform-field-label--type-inline'>Douleurs aux \u00e9paules<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_14_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.4' type='checkbox'  value='Douleurs dans le bas du dos'  id='choice_19_14_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_4' id='label_19_14_4' class='gform-field-label gform-field-label--type-inline'>Douleurs dans le bas du dos<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_14_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.5' type='checkbox'  value='Douleurs au bassin'  id='choice_19_14_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_5' id='label_19_14_5' class='gform-field-label gform-field-label--type-inline'>Douleurs au bassin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_14_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.6' type='checkbox'  value='Autre'  id='choice_19_14_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_6' id='label_19_14_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_15\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_15'><span class='gform-field-label__text'>Si autre, quels douleurs avez-vous?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_19_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>11. Avez-vous adapt\u00e9 votre oreiller \u00e0 votre matelas actuel? Si oui, comment ?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_16'>\n\t\t\t<li class='gchoice gchoice_19_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='J&#039;ai le m\u00eame oreiller'  id='choice_19_16_0'    \/>\n\t\t\t\t<label for='choice_19_16_0' id='label_19_16_0' class='gform-field-label gform-field-label--type-inline'>J'ai le m\u00eame oreiller<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='J&#039;ai maintenant un oreiller plus \u00e9pais'  id='choice_19_16_1'    \/>\n\t\t\t\t<label for='choice_19_16_1' id='label_19_16_1' class='gform-field-label gform-field-label--type-inline'>J'ai maintenant un oreiller plus \u00e9pais<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_16_2'>\n\t\t\t\t<input name='input_16' type='radio' value='J&#039;ai maintenant un oreiller plus fin'  id='choice_19_16_2'    \/>\n\t\t\t\t<label for='choice_19_16_2' id='label_19_16_2' class='gform-field-label gform-field-label--type-inline'>J'ai maintenant un oreiller plus fin<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>12. Le matelas r\u00e9pond-il \u00e0 vos attentes?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_19'>\n\t\t\t<li class='gchoice gchoice_19_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Oui'  id='choice_19_19_0'    \/>\n\t\t\t\t<label for='choice_19_19_0' id='label_19_19_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='Non'  id='choice_19_19_1'    \/>\n\t\t\t\t<label for='choice_19_19_1' id='label_19_19_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_20\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_20'><span class='gform-field-label__text'>Pour quelle raison le matelas ne r\u00e9pond pas \u00e0 vos attentes?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_19_20' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_21\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_21'><span class='gform-field-label__text'>13. Dans quelle mesure recommanderiez-vous Equilli \u00e0 vos amis, votre famille ou vos connaissances pour l&#039;achat d&#039;un nouveau syst\u00e8me de lit?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_19_21' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choisissez votre score' selected='selected'>Choisissez votre score<\/option><option value='10 - absolument \u00e0 recommander' >10 - absolument \u00e0 recommander<\/option><option value='9' >9<\/option><option value='8' >8<\/option><option value='7' >7<\/option><option value='6' >6<\/option><option value='5' >5<\/option><option value='4' >4<\/option><option value='3' >3<\/option><option value='2' >2<\/option><option value='1 - absolument pas \u00e0 recommander' >1 - absolument pas \u00e0 recommander<\/option><\/select><\/div><\/li><li id=\"field_19_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>13. Comment avez-vous connu la marque Equilli pour la premi\u00e8re fois?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_43'>\n\t\t\t<li class='gchoice gchoice_19_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='Par des amis ou des connaissances'  id='choice_19_43_0'    \/>\n\t\t\t\t<label for='choice_19_43_0' id='label_19_43_0' class='gform-field-label gform-field-label--type-inline'>Par des amis ou des connaissances<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='Par publicit\u00e9 radio'  id='choice_19_43_1'    \/>\n\t\t\t\t<label for='choice_19_43_1' id='label_19_43_1' class='gform-field-label gform-field-label--type-inline'>Par publicit\u00e9 radio<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='En ligne (p.e. Google)'  id='choice_19_43_2'    \/>\n\t\t\t\t<label for='choice_19_43_2' id='label_19_43_2' class='gform-field-label gform-field-label--type-inline'>En ligne (p.e. 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id=\"field_19_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_44'><span class='gform-field-label__text'>Si autre, merci de pr\u00e9ciser:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_19_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_19_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description 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