{"id":2077,"date":"2026-02-18T10:38:59","date_gmt":"2026-02-18T10:38:59","guid":{"rendered":"https:\/\/pasteurclinique.com\/conciergerie-medicale\/patient-international\/"},"modified":"2026-04-29T07:06:44","modified_gmt":"2026-04-29T07:06:44","slug":"patient-international","status":"publish","type":"page","link":"https:\/\/pasteurclinique.com\/en\/formulaires-patients\/patient-international\/","title":{"rendered":"Formulaire Patient International"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2077\" class=\"elementor elementor-2077 elementor-bc-flex-widget\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-formintl1 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"formintl1\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-formintl1col\" data-id=\"formintl1col\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-formintl1hd elementor-widget elementor-widget-heading\" data-id=\"formintl1hd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Demande de prise en charge \u2014 Patient International<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-formintl1txt elementor-widget elementor-widget-text-editor\" data-id=\"formintl1txt\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Bienvenue \u00e0 la Clinique Pasteur de Dakar. Remplissez le formulaire ci-dessous pour nous faire part de vos besoins m\u00e9dicaux. Notre \u00e9quipe vous recontactera dans les <strong>24 \u00e0 48 heures<\/strong> pour organiser votre prise en charge compl\u00e8te.<\/p><p><em>Welcome to Clinique Pasteur Dakar. Please fill out the form below to share your medical needs. Our team will contact you within <strong>24 to 48 hours<\/strong> to arrange your complete care.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-formintl1sc elementor-widget elementor-widget-shortcode\" data-id=\"formintl1sc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-0\"><form id=\"wpforms-form-2094\" class=\"wpforms-validate wpforms-form\" data-formid=\"2094\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/2077\" data-token=\"3eb1f30acd614b31597f1001c5938d19\" data-token-time=\"1779647820\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-0-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_1\">Pr\u00e9nom et Nom \/ First and Last Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-0-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-0-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_2\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-0-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-0-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_3\">T\u00e9l\u00e9phone \/ Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-0-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-0-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_4\">Pays de r\u00e9sidence \/ Country <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-0-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-0-field_5-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_5\">Sp\u00e9cialit\u00e9 souhait\u00e9e \/ Requested Specialty <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-0-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required=\"required\"><option value=\"Cardiologie\"  class=\"choice-0 depth-1\"  >Cardiologie<\/option><option value=\"Chirurgie\"  class=\"choice-1 depth-1\"  >Chirurgie<\/option><option value=\"Maternit\u00e9 \/ Gyn\u00e9cologie\"  class=\"choice-2 depth-1\"  >Maternit\u00e9 \/ Gyn\u00e9cologie<\/option><option value=\"Radiologie \/ Imagerie\"  class=\"choice-3 depth-1\"  >Radiologie \/ Imagerie<\/option><option value=\"Urgences\"  class=\"choice-4 depth-1\"  >Urgences<\/option><option value=\"Autre \/ Other\"  class=\"choice-5 depth-1\"  >Autre \/ Other<\/option><\/select><\/div><div id=\"wpforms-0-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_6\">Date souhait\u00e9e \/ Preferred Date<\/label><input type=\"text\" id=\"wpforms-0-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-0-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_7\">Description de votre demande \/ Description of your request<\/label><textarea id=\"wpforms-0-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms--field-hp\" class=\"wpforms-field-label\">Message<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms--field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"0\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/pasteurclinique.com\/en\/wp-json\/wp\/v2\/pages\/2077\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-0\" class=\"wpforms-submit\" data-alt-text=\"Envoi en cours...\" data-submit-text=\"Envoyer ma demande \/ Submit Request\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer ma demande \/ Submit Request<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Demande de prise en charge \u2014 Patient International \/ Medical Request \u2014 International Patient Bienvenue \u00e0 la Clinique Pasteur de Dakar. Remplissez le formulaire ci-dessous pour nous faire part de vos besoins m\u00e9dicaux. Notre \u00e9quipe vous recontactera dans les 24 \u00e0 48 heures pour organiser votre prise en charge compl\u00e8te. Welcome to Clinique Pasteur Dakar. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2076,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2077","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patients Internationaux Dakar | Medical Concierge | Clinique Pasteur<\/title>\n<meta name=\"description\" content=\"Clinique Pasteur Dakar accueille les patients internationaux d&#039;Afrique de l&#039;Ouest et de la diaspora. Conciergerie m\u00e9dicale, transfert a\u00e9roport, h\u00e9bergement. 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