{"id":3690,"date":"2021-09-13T16:11:11","date_gmt":"2021-09-13T20:11:11","guid":{"rendered":"https:\/\/dev.tourmed.ca\/ez-refer-referring-form\/"},"modified":"2025-05-27T15:57:57","modified_gmt":"2025-05-27T19:57:57","slug":"ez-refer-2","status":"publish","type":"page","link":"https:\/\/dev.tourmed.ca\/en\/ez-refer-2\/","title":{"rendered":"EZ-Refer referring form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3690\" class=\"elementor elementor-3690 elementor-319\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6953b97 stickymtop e-flex e-con-boxed e-con e-parent\" data-id=\"6953b97\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-06fac1c e-con-full e-flex e-con e-child\" data-id=\"06fac1c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-361106b elementor-widget elementor-widget-heading\" data-id=\"361106b\" 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<h1 class=\"elementor-heading-title elementor-size-default\">EZ-Refer referring form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e3a5eb elementor-widget elementor-widget-text-editor\" data-id=\"6e3a5eb\" 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>To be used by authorized referring parties only. You don\u2019t have a code and wish to become a representative? <a href=\"https:\/\/dev.tourmed.ca\/en\/become-a-representative\/\">Use this form instead.<\/a><\/p><p>Please fill out this short form. An agent from Customer Service will call the client at the desired time <span style=\"color: #ff0000;\">(Monday to Friday, between 8:30 AM and 5:00 PM EST, except on Holidays).\u00a0<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9855f78 e-con-full tm-rc-lr e-flex elementor-invisible e-con e-child\" data-id=\"9855f78\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;background_motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateY_effect&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateY_speed&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]},&quot;background_motion_fx_translateY_direction&quot;:&quot;negative&quot;,&quot;animation&quot;:&quot;fadeInDown&quot;,&quot;background_motion_fx_range&quot;:&quot;viewport&quot;,&quot;background_motion_fx_translateY_affectedRange&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:{&quot;start&quot;:0,&quot;end&quot;:100}},&quot;background_motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-134e65c elementor-widget__width-auto elementor-absolute elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"134e65c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_position&quot;:&quot;absolute&quot;}\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg class=\"text-red-500 fill-current w-18 h-auto xl:w-28\" viewBox=\"0 0 210 210\"><path d=\"m140 140v70h-70v-70zm-70-70v70h-70v-70zm140 0v70h-70v-70zm-70-70v70h-70v-70z\" fill-rule=\"evenodd\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a21648b e-flex e-con-boxed e-con e-parent\" data-id=\"a21648b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aba7173 elementor-widget elementor-widget-html\" data-id=\"aba7173\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"text\/javascript\">\r\n    document.addEventListener('DOMContentLoaded', function() {\r\n        \/\/ D\u00e9tecte la langue WPML pour v2\r\n        var lang = \"<?php echo (defined('ICL_LANGUAGE_CODE') && ICL_LANGUAGE_CODE == 'fr') ? 'fr' : 'en'; ?>\";\r\n\r\n        \/\/ Cr\u00e9e le script reCAPTCHA pour la langue choisie\r\n        var recaptchaScript = document.createElement('script');\r\n        recaptchaScript.src = \"https:\/\/www.google.com\/recaptcha\/api.js?hl=\" + lang;\r\n        recaptchaScript.async = true;\r\n        recaptchaScript.defer = true;\r\n        document.head.appendChild(recaptchaScript);\r\n    });\r\n<\/script>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd29c08 elementor-button-align-end elementor-widget elementor-widget-form\" data-id=\"fd29c08\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"EZ-Refer EN\" aria-label=\"EZ-Refer EN\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"3690\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"fd29c08\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"EZ-Refer referring form - Tour+Med\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_type\" value=\"WP_Post\"\/><input type=\"hidden\" name=\"queried_id\" value=\"3690\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-coderef elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-coderef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReferral code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Oui\" id=\"form-field-coderef-0\" name=\"form_fields[coderef]\" required=\"required\"> <label for=\"form-field-coderef-0\">Code<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non\" id=\"form-field-coderef-1\" name=\"form_fields[coderef]\" required=\"required\"> <label for=\"form-field-coderef-1\">I forgot my code<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-votrecode elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-votrecode\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[votrecode]\" id=\"form-field-votrecode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"(Starts with R or RE)\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-votrecourriel elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-votrecourriel\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Email Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[votrecourriel]\" id=\"form-field-votrecourriel\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_07c237b elementor-col-100\">\n\t\t\t\t\t<span style='color:var(--e-global-color-primary);'>Customer Contact Details\r\n<\/span>\r\n<br>\r\n<hr>\r\n<br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_915e370 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_915e370\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_915e370]\" id=\"form-field-field_915e370\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9aec9f2 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9aec9f2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9aec9f2]\" id=\"form-field-field_9aec9f2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-joindreleclient elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-joindreleclient\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBest moment to call them back\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"D\u00e8s que possible\" id=\"form-field-joindreleclient-0\" name=\"form_fields[joindreleclient]\" required=\"required\"> <label for=\"form-field-joindreleclient-0\">As soon as possible (max 4 business hours)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u00c0 un autre moment\" id=\"form-field-joindreleclient-1\" name=\"form_fields[joindreleclient]\" required=\"required\"> <label for=\"form-field-joindreleclient-1\">At another time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-dateetheure elementor-col-33\" style=\"display:none;\" >\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dateetheure\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate and time\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[dateetheure]\" id=\"form-field-dateetheure\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMessage\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"8\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_fe01fc6]\" id=\"form-field-field_fe01fc6\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha elementor-field-group elementor-column elementor-field-group-field_030143d elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_030143d\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6Le_ZWMqAAAAAKR_AnbTBZ_CmKO0UewhU4uJ0MFu\" data-type=\"v2_checkbox\" data-theme=\"light\" data-size=\"normal\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send my request<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-065dcbf e-flex e-con-boxed e-con e-parent\" data-id=\"065dcbf\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-998333c elementor-widget elementor-widget-html\" data-id=\"998333c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script>\nwindow.addEventListener(\"load\", function(){\n    var dateContact = document.querySelector(\"#content > div > div > div.elementor-element.elementor-element-a21648b.e-flex.e-con-boxed.e-con.e-parent.e-lazyloaded > div > div > div > form > div > 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You don\u2019t have a code and wish to become a representative? Use this form instead. Please fill out this short form. An agent from Customer Service will call the client at the desired time (Monday to Friday, between 8:30 AM and 5:00 PM EST, [&hellip;]<\/p>\n","protected":false},"author":12,"featured_media":3279,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3690","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/pages\/3690","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/comments?post=3690"}],"version-history":[{"count":0,"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/pages\/3690\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/media\/3279"}],"wp:attachment":[{"href":"https:\/\/dev.tourmed.ca\/en\/wp-json\/wp\/v2\/media?parent=3690"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}