{"id":1102,"date":"2017-03-31T19:30:16","date_gmt":"2017-03-31T18:30:16","guid":{"rendered":"http:\/\/audiapason.org\/en\/?page_id=1102"},"modified":"2017-03-31T19:30:16","modified_gmt":"2017-03-31T18:30:16","slug":"care-and-services-satisfaction-evaluation-form","status":"publish","type":"page","link":"https:\/\/audiapason.org\/en\/care-and-services-satisfaction-evaluation-form\/","title":{"rendered":"Care And Services Satisfaction Evaluation Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1101-o1\" lang=\"fr-FR\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1102#wpcf7-f1101-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1101\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1101-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p>For each statement, please check the box that corresponds to the degree to which you agree or disagree.\n<\/p>\n<p>There are no right or wrong answers.\n<\/p>\n<p>1 = strongly agree<br \/>\n2 = agree<br \/>\n3 = disagree<br \/>\n4 = strongly disagree<br \/>\n5 = N\/A\n<\/p>\n<p>ATTITUDE OF THE TEAM MEMBERS\n<\/p>\n<p>The team was curteous and polite.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-649\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-649[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-649[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-649[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-649[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-649[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Our privacy was respected.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-247\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-247[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-247[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-247[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-247[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-247[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Our personnal information was kept confidential.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-248\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-248[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-248[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-248[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-248[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-248[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>The team was present and available to respond to our needs.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-249\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-249[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-249[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-249[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-249[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-249[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>QUALITY OF THE ENVIRONMENT\n<\/p>\n<p>La Maison Au Diapason was a calm environment.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-250\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-250[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-250[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-250[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-250[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-250[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>The room was adapted to our needs.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-251\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-251[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-251[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-251[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-251[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-251[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>The common areas were accessible.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-252\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-252[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-252[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-252[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-252[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-252[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>La Maison Au Diapason was kept clean and well maintained.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-253\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-253[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-253[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-253[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-253[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-253[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>QUALITY OF CARE AND SERVICES\n<\/p>\n<p>We received a warm welcome and were given the information and support we needed upon arrival.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-254\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-254[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-254[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-254[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-254[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-254[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>My pain \/ my loved one\u2019s pain was well managed.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-255\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-255[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-255[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-255[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-255[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-255[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Symptoms were well managed (for example:nausea, vomiting, anxiety, constipation, etc.).\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-256\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-256[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-256[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-256[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-256[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-256[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>There was good continuity of care throughout our stay (for example: we didn\u2019t need to repeat the same information day after day).\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-257\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-257[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-257[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-257[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-257[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-257[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>I \/ my loved one was cared for safely and securely (for example: the caregivers washed their hands prior to entering and upon leaving his room).\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-258\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-258[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-258[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-258[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-258[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-258[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Caregivers took the time to explain the disease and its evolution, care objectives and medication in plain language.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-259\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-259[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-259[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-259[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-259[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-259[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Caregivers were sensitive to our needs; I felt listened to and cared for.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-260\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Dietary needs were met (for example: the availability of an adapted diet).\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-261\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Special requests were respected (for example: calls transferred to the room, limited visiting hours).\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-262\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>GENERAL EVALUATION\n<\/p>\n<p>Overall, I am satisfied with the care and services at La Maison Au Diapason.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-263\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Please provide any additional feedback to assist us in our efforts to improve the quality of care and services offered at La Maison Au Diapason.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-271\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-271\"><\/textarea><\/span>\n<\/p>\n<p>Date\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-688\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" placeholder=\"Date\" value=\"\" type=\"date\" name=\"date-688\" \/><\/span>\n<\/p>\n<p>Your name (optional)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-96\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-96\" \/><\/span>\n<\/p>\n\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"_links":{"self":[{"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/pages\/1102"}],"collection":[{"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/comments?post=1102"}],"version-history":[{"count":1,"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/pages\/1102\/revisions"}],"predecessor-version":[{"id":1103,"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/pages\/1102\/revisions\/1103"}],"wp:attachment":[{"href":"https:\/\/audiapason.org\/en\/wp-json\/wp\/v2\/media?parent=1102"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}