{"id":2078,"date":"2026-02-18T10:38:59","date_gmt":"2026-02-18T10:38:59","guid":{"rendered":"https:\/\/pasteurclinique.com\/conciergerie-medicale\/patient-senegalais\/"},"modified":"2026-04-29T07:06:48","modified_gmt":"2026-04-29T07:06:48","slug":"patient-senegalais","status":"publish","type":"page","link":"https:\/\/pasteurclinique.com\/en\/formulaires-patients\/patient-senegalais\/","title":{"rendered":"Formulaire Patient S\u00e9n\u00e9galais"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2078\" class=\"elementor elementor-2078 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-formsn1 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"formsn1\" 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-formsn1col\" data-id=\"formsn1col\" 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-formsn1hd elementor-widget elementor-widget-heading\" data-id=\"formsn1hd\" 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 consultation \u2014 Patient S\u00e9n\u00e9galais<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-formsn1txt elementor-widget elementor-widget-text-editor\" data-id=\"formsn1txt\" 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 prendre rendez-vous ou demander une consultation avec nos sp\u00e9cialistes. Notre \u00e9quipe vous recontactera rapidement pour confirmer votre rendez-vous.<\/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-formsn1sc elementor-widget elementor-widget-shortcode\" data-id=\"formsn1sc\" 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-2095\" class=\"wpforms-validate wpforms-form\" data-formid=\"2095\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/2078\" data-token=\"3eb1f30acd614b31597f1001c5938d19\" data-token-time=\"1779647811\"><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 <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<\/label><input type=\"email\" id=\"wpforms-0-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" spellcheck=\"false\" ><\/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\">Num\u00e9ro de t\u00e9l\u00e9phone <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-select\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_4\">Sp\u00e9cialit\u00e9 souhait\u00e9e <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-0-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" 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=\"M\u00e9decine g\u00e9n\u00e9rale\"  class=\"choice-5 depth-1\"  >M\u00e9decine g\u00e9n\u00e9rale<\/option><option value=\"Autre\"  class=\"choice-6 depth-1\"  >Autre<\/option><\/select><\/div><div id=\"wpforms-0-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_5\">Date souhait\u00e9e pour le rendez-vous<\/label><input type=\"text\" id=\"wpforms-0-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" ><\/div><div id=\"wpforms-0-field_6-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-0-field_6\">Couverture m\u00e9dicale<\/label><select id=\"wpforms-0-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\"><option value=\"Aucune (paiement direct)\"  class=\"choice-0 depth-1\"  >Aucune (paiement direct)<\/option><option value=\"IPM\"  class=\"choice-1 depth-1\"  >IPM<\/option><option value=\"Assurance maladie\"  class=\"choice-2 depth-1\"  >Assurance maladie<\/option><option value=\"CASEM\"  class=\"choice-3 depth-1\"  >CASEM<\/option><option value=\"Autre\"  class=\"choice-4 depth-1\"  >Autre<\/option><\/select><\/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\">Message ou pr\u00e9cisions suppl\u00e9mentaires<\/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\/2078\"><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\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer ma demande<\/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 consultation \u2014 Patient S\u00e9n\u00e9galais Bienvenue \u00e0 la Clinique Pasteur de Dakar. Remplissez le formulaire ci-dessous pour prendre rendez-vous ou demander une consultation avec nos sp\u00e9cialistes. Notre \u00e9quipe vous recontactera rapidement pour confirmer votre rendez-vous.<\/p>","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-2078","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>Demande de Consultation | Patient S\u00e9n\u00e9galais | Clinique Pasteur Dakar<\/title>\n<meta name=\"description\" content=\"Prenez rendez-vous en ligne \u00e0 la Clinique Pasteur de Dakar. Formulaire de demande pour patients s\u00e9n\u00e9galais. 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