{"id":7367,"date":"2022-07-12T14:49:10","date_gmt":"2022-07-12T13:49:10","guid":{"rendered":"https:\/\/vidalassurances.ma%d8%aa%d8%a3%d9%85%d9%8a%d9%86-%d8%b5%d8%ad%d9%8a\/%d8%b7%d9%84%d8%a8-%d8%b9%d8%b1%d8%b6-%d8%a3%d8%b3%d8%b9%d8%a7%d8%b1-%d8%a7%d9%84%d8%aa%d8%a3%d9%85%d9%8a%d9%86-%d8%a7%d9%84%d8%b5%d8%ad%d9%8a\/"},"modified":"2024-04-27T16:11:22","modified_gmt":"2024-04-27T15:11:22","slug":"demande-devis-assurance-sante","status":"publish","type":"page","link":"https:\/\/www.vidalassurances.ma\/ar\/assurance-sante\/demande-devis-assurance-sante\/","title":{"rendered":"\u0637\u0644\u0628 \u0639\u0631\u0636 \u0623\u0633\u0639\u0627\u0631 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0635\u062d\u064a"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling lazyload\" style=\"--awb-background-position:center 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fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-8024\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;\" data-form-id=\"8024\" data-config=\"{&quot;form_id&quot;:8024,&quot;form_post_id&quot;:8024,&quot;post_id&quot;:7367,&quot;form_type&quot;:&quot;ajax&quot;,&quot;confirmation_type&quot;:&quot;message&quot;,&quot;redirect_url&quot;:&quot;#&quot;,&quot;field_labels&quot;:{&quot;Plans_sante&quot;:&quot;&quot;,&quot;Beneficiaires_moi&quot;:&quot;&quot;,&quot;ma_date_naissance&quot;:&quot;\\u062a\\u0627\\u0631\\u064a\\u062e \\u0627\\u0632\\u062f\\u064a\\u0627\\u062f\\u064a&quot;,&quot;Beneficiaires_conjoint&quot;:&quot;&quot;,&quot;date_de_naissance_-_conjoint&quot;:&quot;\\u062a\\u0627\\u0631\\u064a\\u062e \\u0627\\u0644\\u0645\\u064a\\u0644\\u0627\\u062f - \\u0627\\u0644\\u0632\\u0648\\u062c&quot;,&quot;Beneficiaires_enfants&quot;:&quot;&quot;,&quot;date_naissance_enfant_1&quot;:&quot;\\u062a\\u0627\\u0631\\u064a\\u062e \\u0627\\u0644\\u0645\\u064a\\u0644\\u0627\\u062f - \\u0627\\u0644\\u0637\\u0641\\u0644 1&quot;,&quot;date_naissance_enfant_2&quot;:&quot;\\u062a\\u0627\\u0631\\u064a\\u062e \\u0627\\u0644\\u0645\\u064a\\u0644\\u0627\\u062f - \\u0627\\u0644\\u0637\\u0641\\u0644 2&quot;,&quot;date_naissance_enfant_3&quot;:&quot;\\u062a\\u0627\\u0631\\u064a\\u062e \\u0627\\u0644\\u0645\\u064a\\u0644\\u0627\\u062f - \\u0627\\u0644\\u0637\\u0641\\u0644 3&quot;,&quot;nom&quot;:&quot;\\u0627\\u0633\\u0645&quot;,&quot;prenom&quot;:&quot;\\u0627\\u0644\\u0627\\u0633\\u0645 \\u0627\\u0644\\u0623\\u0648\\u0644&quot;,&quot;telephone&quot;:&quot;\\u0631\\u0642\\u0645 \\u0647\\u0627\\u062a\\u0641&quot;,&quot;email&quot;:&quot;\\u0628\\u0631\\u064a\\u062f 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action=\"https:\/\/www.vidalassurances.ma\/ar\/assurance-sante\/demande-devis-assurance-sante\/\" method=\"post\" class=\"fusion-form fusion-form-8024\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top-small:0px;--awb-padding-right-small:0px;--awb-padding-bottom-small:0px;--awb-padding-left-small:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-margin-top-medium:0px;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-margin-top-small:0px;--awb-spacing-right-small:1.92%;--awb-margin-bottom-small:0px;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;--awb-margin-bottom-medium:12px;\"><h4 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:20;line-height:1.4;\">\u062e\u0637\u0629 (\u062e\u0637\u0637) \u0635\u062d\u064a\u0629<\/h4><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-flex-start\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:1;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:1;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"8024\"><fieldset><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-plans_sante-1-0\" type=\"radio\" value=\"\u0635\u062d\u0629 \u0627\u0644\u0645\u063a\u0631\u0628\" name=\"Plans_sante\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"radio-plans_sante-1-0\">\u0635\u062d\u0629 \u0627\u0644\u0645\u063a\u0631\u0628<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-plans_sante-1-1\" type=\"radio\" value=\"\u0635\u062d\u0629 \u0627\u0644\u0645\u063a\u0631\u0628 + \u062f\u0648\u0644\u064a\u0629\" name=\"Plans_sante\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"radio-plans_sante-1-1\">\u0635\u062d\u0629 \u0627\u0644\u0645\u063a\u0631\u0628 + \u062f\u0648\u0644\u064a\u0629<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:2;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-margin-top-medium:0px;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:2;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-margin-top-small:0px;--awb-spacing-right-small:1.92%;--awb-margin-bottom-small:0px;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;--awb-margin-bottom-medium:12px;\"><h4 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:20;line-height:1.4;\">\u0627\u0644\u0645\u0633\u062a\u0641\u064a\u062f (\u0627\u0644\u0645\u0633\u062a\u0641\u064a\u062f\u0648\u0646)<\/h4><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_3 1_3 fusion-flex-column fusion-flex-align-self-flex-start\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:33.333333333333%;--awb-order-medium:3;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:5.76%;--awb-spacing-left-medium:5.76%;--awb-width-small:100%;--awb-order-small:3;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"checkbox_1\"><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-beneficiaires_moi-1-0\" type=\"checkbox\" value=\"oui\" name=\"Beneficiaires_moi[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-beneficiaires_moi-1-0\">\u0645\u0648\u064a<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_1\"><label for=\"ma_date_naissance\">\u062a\u0627\u0631\u064a\u062e \u0627\u0632\u062f\u064a\u0627\u062f\u064a <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"ma_date_naissance\" name=\"ma_date_naissance\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"jj\/mm\/aaaa *\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_3 1_3 fusion-flex-column fusion-flex-align-self-flex-start\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:33.333333333333%;--awb-order-medium:3;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:5.76%;--awb-spacing-left-medium:5.76%;--awb-width-small:100%;--awb-order-small:3;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"checkbox_2\"><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-beneficiaires_conjoint-2-0\" type=\"checkbox\" value=\"oui\" name=\"Beneficiaires_conjoint[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-beneficiaires_conjoint-2-0\">\u0634\u0631\u064a\u0643\u0649<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_2\"><label for=\"date_de_naissance_-_conjoint\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f - \u0627\u0644\u0632\u0648\u062c <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"date_de_naissance_-_conjoint\" name=\"date_de_naissance_-_conjoint\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"jj\/mm\/aaaa *\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_3 1_3 fusion-flex-column fusion-flex-align-self-flex-start\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:33.333333333333%;--awb-order-medium:4;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:5.76%;--awb-spacing-left-medium:5.76%;--awb-width-small:100%;--awb-order-small:3;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"checkbox_3\"><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-beneficiaires_enfants-3-0\" type=\"checkbox\" value=\"oui\" name=\"Beneficiaires_enfants[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-beneficiaires_enfants-3-0\">\u0627\u0637\u0641\u0627\u0644\u064a<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_3\"><label for=\"date_naissance_enfant_1\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f - \u0627\u0644\u0637\u0641\u0644 1<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"date_naissance_enfant_1\" name=\"date_naissance_enfant_1\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" placeholder=\"jj\/mm\/aaaa \"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_4\"><label for=\"date_naissance_enfant_2\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f - \u0627\u0644\u0637\u0641\u0644 2<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"date_naissance_enfant_2\" name=\"date_naissance_enfant_2\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" placeholder=\"jj\/mm\/aaaa \"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_5\"><label for=\"date_naissance_enfant_3\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f - \u0627\u0644\u0637\u0641\u0644 3<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"date_naissance_enfant_3\" name=\"date_naissance_enfant_3\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" placeholder=\"jj\/mm\/aaaa \"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:5;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:4;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-margin-top-small:15px;--awb-spacing-right-small:1.92%;--awb-margin-bottom-small:0px;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-four no-margin-top\" style=\"--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;--awb-margin-top-medium:0px;--awb-margin-bottom-medium:0px;\"><h4 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:20;line-height:1.4;\">\u0628\u064a\u0627\u0646\u0627\u062a \u0627\u0644\u0645\u062a\u0635\u0644<\/h4><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:6;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:5;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"8024\"><div class=\"fusion-form-label-wrapper\"><label for=\"nom\">\u0627\u0633\u0645 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"nom\" id=\"nom\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-9 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:7;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:6;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"8024\"><div class=\"fusion-form-label-wrapper\"><label for=\"prenom\">\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u0623\u0648\u0644 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-user fas\"><\/i><input type=\"text\" autocomplete=\"off\" name=\"prenom\" id=\"prenom\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-10 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:8;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:7;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"8024\"><div class=\"fusion-form-label-wrapper\"><label for=\"telephone\">\u0631\u0642\u0645 \u0647\u0627\u062a\u0641 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"telephone\" id=\"telephone\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-11 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:9;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:8;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"8024\"><div class=\"fusion-form-label-wrapper\"><label for=\"email\">\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-at fas\"><\/i><input type=\"email\" autocomplete=\"off\" name=\"email\" id=\"email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-12 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:5px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:10;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:9;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-margin-top-small:15px;--awb-spacing-right-small:1.92%;--awb-margin-bottom-small:0px;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;--awb-margin-top-medium:0px;--awb-margin-bottom-medium:0px;\"><h4 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:20;line-height:1.4;\">\u0639\u0646\u062f\u0645\u0627 \u0647\u0648 \u0623\u0641\u0636\u0644 \u0648\u0642\u062a \u0644\u0644\u0648\u0635\u0648\u0644 \u0644\u0643\u061f<\/h4><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-13 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-padding-top:0px;--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:11;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:10;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-margin-bottom-small:0px;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above check-conditions\" style=\"\" data-form-id=\"8024\"><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-aucune_preference_contact-4-0\" type=\"checkbox\" value=\"true\" name=\"aucune_preference_contact[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-aucune_preference_contact-4-0\">\u0628\u062f\u0648\u0646 \u062a\u0641\u0636\u064a\u0644<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-14 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:12;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:11;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"date_6\"><label for=\"date_disponibilite\">\u062c\u0648\u0631<\/label><div class=\"fusion-form-input-with-icon\"><i class=\"fa-calendar-alt fas\"><\/i><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"d\/m\/Y\" tabindex=\"\" id=\"date_disponibilite\" name=\"date_disponibilite\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" placeholder=\"\u0627\u062e\u062a\u0631 \u0627\u0644\u064a\u0648\u0645 \"autocomplete=\"no\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-15 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:50%;--awb-order-medium:13;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:3.84%;--awb-spacing-left-medium:3.84%;--awb-width-small:100%;--awb-order-small:12;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above fusion-form-field-hidden\" style=\"\" data-form-id=\"8024\" data-form-element-name=\"select_1\"><label for=\"heure_disponibilite\">\u0633\u0627\u0639\u064a\u0627<\/label><div class=\"fusion-form-input-with-icon\"><i class=\" fa-clock fas\"><\/i><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"heure_disponibilite\" name=\"heure_disponibilite\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"\" disabled selected>Choisir un horaire<\/option><option value=\"08:30\" >08:30 - 09:00<\/option><option value=\"09:00\" >09:00 - 09:30<\/option><option value=\"09:30\" >09:30 - 10:00<\/option><option value=\"10:00\" >10:00 - 10:30<\/option><option value=\"10:30\" >10:30 - 11:00<\/option><option value=\"11:00\" >11:00 - 11:30<\/option><option value=\"11:30\" >11:30 - 12:00<\/option><option value=\"12:00\" >12:00 - 12:30<\/option><option value=\"12:30\" >12:30 - 13:00<\/option><option value=\"13:00\" >13:00 - 13:30<\/option><option value=\"13:30\" >13:30 - 14:00<\/option><option value=\"14:00\" >14:00 - 14:30<\/option><option value=\"14:30\" >14:30 - 15:00<\/option><option value=\"15:00\" >15:00 - 15:30<\/option><option value=\"15:30\" >15:30 - 15:30<\/option><option value=\"16:00\" >15:30 - 16:00<\/option><option value=\"16:00\" >16:00 - 16:30<\/option><option value=\"17:00\" >17:00 - 17:30<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-16 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:14;--awb-flex-grow-medium:0;--awb-flex-shrink-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:13;--awb-flex-grow-small:0;--awb-flex-shrink-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"form-submission-notices data-notice_1\" id=\"fusion-notices-1\"><div class=\"fusion-alert alert success alert-success fusion-alert-center fusion-form-response fusion-form-response-success awb-alert-native-link-color alert-dismissable awb-alert-close-boxed alert-shadow\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-check-circle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">\u0645\u064a\u0631\u0633\u064a! \u062a\u0645 \u0627\u0631\u0633\u0627\u0644 \u0637\u0644\u0628\u0643. \u0633\u064a\u062a\u0635\u0644 \u0628\u0643 \u0623\u062d\u062f \u0648\u0643\u0644\u0627\u0621 Vidal Assurances \u0641\u064a \u0623\u0642\u0631\u0628 \u0648\u0642\u062a \u0645\u0645\u0643\u0646.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><div class=\"fusion-alert alert error alert-danger fusion-alert-center fusion-form-response fusion-form-response-error awb-alert-native-link-color alert-dismissable awb-alert-close-boxed alert-shadow\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-exclamation-triangle\" aria-hidden=\"true\"><\/i><\/span><span 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