{"id":6391,"date":"2020-05-25T21:15:46","date_gmt":"2020-05-25T19:15:46","guid":{"rendered":"https:\/\/excellemd.com\/en\/?page_id=6391"},"modified":"2022-08-23T21:24:50","modified_gmt":"2022-08-23T19:24:50","slug":"payment","status":"publish","type":"page","link":"https:\/\/excellemd.com\/en\/payment\/","title":{"rendered":"Payment"},"content":{"rendered":"<style type=\"text\/css\" id=\"111\" data-form-unique-id=\"47837\" ><\/style><div class=\"arf_form ar_main_div_111 arf_form_outer_wrapper \" id=\"arffrm_111_container\"><div id=\"arf_message_error\" class=\"frm_error_style\" style=\"display:none;\"><div class=\"msg-detail\"><div class=\"msg-description-success\">Form Submission is restricted<\/div><\/div><\/div><div id=\"arf_message_success_popup\" style=\"display:none;\"><div class=\"msg-detail\"><div class=\"msg-description-success\">Thanks for the payment !<\/div><\/div><\/div><form enctype=\"multipart\/form-data\" method=\"post\" class=\"arfshowmainform  \" style=\"\" data-form-id=\"form_ngdjtp\"  novalidate=\"\" onsubmit=\"return arf_validate_form_submit()\" arf_form_submit = 0 data-id=\"47837\"  data-random-id=\"111_2NmCdx8PKX\"  data-submission-key=\"Iv3VwM1F\"  data-key-validate=\"false\"  data-popup-id=\"\"><label for='arf_filter_input_111_2NmCdx8PKX' class='arf_hidden_element' style='color:transparent !important;'>Filter<\/label><input id='arf_filter_input_111_2NmCdx8PKX' type='text' name='arf_filter_input' data-jqvalidate='false' data-random-key='111_2NmCdx8PKX' value='' style='opacity:0 !important;display:none !important;visibility:hidden !important;' \/><input type='hidden' id='arf_ajax_url' value='https:\/\/excellemd.com\/wp-admin\/admin-ajax.php' \/><input type=\"hidden\" data-jqvalidate=\"false\" class=\"kpress\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" class=\"stime\" value=\"1775419883\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"nonce_start_time\" class=\"nonce_start_time\" value=\"form_filter_st\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"nonce_keyboard_press\" class=\"nonce_keyboard_press\" value=\"form_filter_kp\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"arm_nonce_check\" name=\"arm_nonce_check\" value=\"e965b1de3f\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_redirect_url_to\" id=\"arf_redirect_url_to\" value=\"same_tab\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_browser_name\" data-id=\"arf_browser_name\" data-version=\"unknown\" value=\"Unknown\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arforms_nonce\" id=\"arforms_nonce\" value=\"c05b781fda\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfdecimal_separator\" data-id=\"arfdecimal_separator\" value=\".\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key_111\" data-id=\"form_key_111\" value=\"ngdjtp\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_success_message_show_time_111\" data-id=\"arf_success_message_show_time_111\" value=\"3\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_hide_after_submit_111\" data-id=\"arf_form_hide_after_submit_111\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"is_form_preview_111\" data-id=\"is_form_preview_111\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_validate_outside_111\" data-id=\"arf_validate_outside_111\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_validate_outside_111\" data-id=\"arf_is_validate_outside_111\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_aftersubmit_111\" data-id=\"arf_is_resetform_aftersubmit_111\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_outside_111\" data-id=\"arf_is_resetform_outside_111\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_enable_cookie_111\" data-id=\"arf_form_enable_cookie_111\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_tooltip_settings_111\" data-id=\"arf_tooltip_settings_111\" class=\"arf_front_tooltip_settings\" data-form-id=\"111\" data-color=\"#FFFFFF\" data-position=\"top\" data-width=\"\" data-bg-color=\"#000000\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfsuccessmsgposition_111\" data-id=\"arfsuccessmsgposition_111\"  value=\"top\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakstyle_111\" data-id=\"arfpagebreakstyle_111\"  value=\"number\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakaddtimer_111\" data-id=\"arfpagebreakaddtimer_111\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_tooltip_error_111\" data-id=\"form_tooltip_error_111\" data-color=\"\" data-position=\"bottom\" value=\"advance\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfaction\" value=\"create\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_id\" data-id=\"form_id\" value=\"111\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_data_id\" data-id=\"form_data_id\" value=\"47837\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key\" data-id=\"form_key\" value=\"ngdjtp\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_ajax_url\" value=\"https:\/\/excellemd.com\/wp-admin\/admin-ajax.php\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_display_type\" data-id=\"form_display_type\" value=\"0|https:\/\/excellemd.com\/en\/payment\/\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_submit_type\" data-id=\"form_submit_type\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_http_referrer_url\" data-id=\"arf_http_referrer_url\" value=\"\" \/><input type=\"hidden\" data-id=\"field_nt5e6b_47837\" name=\"item_meta[758]\" id=\"arf_item_meta_758\"   value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"entry_key\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_skip_captcha\" data-id=\"arf_skip_captcha\" value=\"\" \/><input type='hidden' id='arf_pb_field_animation_style_front_111' name='arf_pb_field_animation_style_front_111' value='slideInLeft' \/><input type='hidden' id='arf_pb_field_animation_duration_front_111' name='arf_pb_field_animation_duration_front_111' value='' \/><input type='hidden' id='arf_pb_field_animation_delay_front_111' name='arf_pb_field_animation_delay_front_111' value='' \/><input type='hidden' id='arf_pb_field_animation_inherit_111' name='arf_pb_field_animation_inherit_111' value='0' \/><input type='hidden' id='arf_field_animation_style_front_111' name='arf_field_animation_style_front_111' value='' \/><input type='hidden' id='arf_field_animation_duration_front_111' name='arf_field_animation_duration_front_111' value='' \/><input type='hidden' id='arf_field_animation_delay_front_111' name='arf_field_animation_delay_front_111' value='' \/><input type=\"hidden\" id=\"arf_form_site_wide_111\" value=\"\" \/><div class=\"allfields\" style=\"visibility:hidden;height:0;\"><div class=\"arf_fieldset arf_standard_form\" id=\"arf_fieldset_47837\"><div class=\"arftitlecontainer\"><div class=\"formtitle_style\">Payment<\/div><\/div><div id=\"page_0\" class=\"page_break\"><div id=\"arf_field_743_47837_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_743\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_98t39l_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Patient's first and last name<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_98t39l_47837\"  name=\"item_meta[743]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_762_47837_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_762\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_epnyz4_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Patient's birthday (YYYY-MM-DD)<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input data-validation-regex-regex=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\"  data-validation-regex-message=\"Entered value is invalid\"  type=\"text\" id=\"field_epnyz4_47837\"  name=\"item_meta[762]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_745_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_745\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_32s021_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >RAMQ (Health insurance number)<\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_32s021_47837\"  name=\"item_meta[745]\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_746_47837_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_email  top_container  arf_inline_field_value   top_container arfformfield  arf_field_746\"  style='width: 100%'  data-field-type=\"email\" data-parent_field=\"0\"><label data-type=\"email\" for=\"field_j7u1df_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Email<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input type=\"text\" id=\"field_j7u1df_47837\" name=\"item_meta[746]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"  data-validation-regex-regex=\"[\\p{L}0-9._-]+@[\\p{L}0-9.-]+\\.[\\p{L}]+\" data-validation-regex-message=\"Email is invalid\"  \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_747_47837_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_747\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_aop1ku_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >First and last name of the credit card owner<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_aop1ku_47837\"  name=\"item_meta[747]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_748_47837_container\" class=\"    arfformfield input-field control-group arfmainformfield  arffieldrequired arf_field_type_select  top_container  top_container arfformfield  arf_field_748\"  style='width: 100%'  data-field-type=\"select\" data-parent_field=\"0\"><label data-type=\"select\" for=\"field_otmmpe_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Choose a service category<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\" sltstandard_front controls\"  ><div class=\"arf_selectpicker_wrapper\" style=\"min-width:100px; \"><input type=\"text\" autocomplete=\"off\" class=\"arf-selectpicker-input-control  arf_dynamic_selectpicker\" id=\"field_otmmpe_47837\" name=\"item_meta[748]\" value=\"Mental health\"  data-default-val='Mental health'  data-validation-required-message='This field cannot be blank.'  data-field_id='748'  data-dynamic-load='arf_load_dynamic_data(748,0, 111, 47837, 0, \"\");'  onchange='arf_cl_apply_v3(47837,{\"0\":\"749\",\"1\":\"750\",\"2\":\"752\",\"3\":\"751\",\"4\":\"\",\"5\":\"753\",\"6\":\"755\",\"9\":\"770\"});' ><dl class=\"arf-selectpicker-control  arf_form_field_picker \" data-id=\"field_otmmpe_47837\" data-name=\"item_meta[748]\"><dt><span>Mental health <\/span><i class=\"arf-selectpicker-caret\"><\/i><\/dt><dd><ul data-id=\"field_otmmpe_47837\" id=\"\" class=\"\"><li class=\"\" data-pos=\"0\" aria-label=\"Emergencies\"  data-value=\"Emergencies\" data-label=\"Emergencies\">Emergencies<\/li><li class=\"\" data-pos=\"1\" aria-label=\"Complete examination \/ follow ups\"  data-value=\"Complete examination \/ follow ups\" data-label=\"Complete examination \/ follow ups\">Complete examination \/ follow ups<\/li><li class=\"\" data-pos=\"2\" aria-label=\"ADHD\"  data-value=\"ADHD\" data-label=\"ADHD\">ADHD<\/li><li class=\"\" data-pos=\"3\" aria-label=\"Mental health\"  data-value=\"Mental health\" data-label=\"Mental health\">Mental health<\/li><li class=\"\" data-pos=\"4\" aria-label=\"Hemato-Oncology\"  data-value=\"Hemato-Oncology\" data-label=\"Hemato-Oncology\">Hemato-Oncology<\/li><li class=\"\" data-pos=\"5\" aria-label=\"TDAH Laval\/Laurentides clinic (Dre Bonnaud)\"  data-value=\"TDAH Laval\/Laurentides clinic (Dre Bonnaud)\" data-label=\"TDAH Laval\/Laurentides clinic (Dre Bonnaud)\">TDAH Laval\/Laurentides clinic (Dre Bonnaud)<\/li><li class=\"\" data-pos=\"6\" aria-label=\"Urology\"  data-value=\"Urology\" data-label=\"Urology\">Urology<\/li><\/ul><\/dd><\/dl><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_749_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_749\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_cah5i_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Emergencies<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_749-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[749][]\" data-type=\"checkbox\" id=\"field_749-0-47837\" value=\"155\" data-label=\"Minor emergency - NP (155$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"749\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"749\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_749-0-47837\" aria-label=\"Minor emergency - NP (155$)\">Minor emergency - NP (155$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_749-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[749][]\" data-type=\"checkbox\" id=\"field_749-1-47837\" value=\"165\" data-label=\"Minor emergency - Dr (165$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"749\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"749\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_749-1-47837\" aria-label=\"Minor emergency - Dr (165$)\">Minor emergency - Dr (165$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_749-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[749][]\" data-type=\"checkbox\" id=\"field_749-2-47837\" value=\"270\" data-label=\"Major emergency - (Dr\/NP) (270$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"749\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"749\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_749-2-47837\" aria-label=\"Major emergency - (Dr\/NP) (270$)\">Major emergency - (Dr\/NP) (270$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_749-3\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[749][]\" data-type=\"checkbox\" id=\"field_749-3-47837\" value=\"125\" data-label=\"Nursing services (125$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"749\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"749\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_749-3-47837\" aria-label=\"Nursing services (125$)\">Nursing services (125$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[749]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_750_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_750\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_yevh7u_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Complete examination \/ follow ups<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_750-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[750][]\" data-type=\"checkbox\" id=\"field_750-0-47837\" value=\"325\" data-label=\"Aviation and diving (325$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"750\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"750\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_750-0-47837\" aria-label=\"Aviation and diving (325$)\">Aviation and diving (325$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_750-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[750][]\" data-type=\"checkbox\" id=\"field_750-1-47837\" value=\"435\" data-label=\"Initial complete examination - Dr \/ NP (435$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"750\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"750\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_750-1-47837\" aria-label=\"Initial complete examination - Dr \/ NP (435$)\">Initial complete examination - Dr \/ NP (435$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_750-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[750][]\" data-type=\"checkbox\" id=\"field_750-2-47837\" value=\"165\" data-label=\"Follow ups - Dr  (165$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"750\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"750\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_750-2-47837\" aria-label=\"Follow ups - Dr  (165$)\">Follow ups - Dr  (165$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_750-3\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[750][]\" data-type=\"checkbox\" id=\"field_750-3-47837\" value=\"340\" data-label=\"Annual examination - Dr \/ NP (340$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"750\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"750\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_750-3-47837\" aria-label=\"Annual examination - Dr \/ NP (340$)\">Annual examination - Dr \/ NP (340$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_750-4\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[750][]\" data-type=\"checkbox\" id=\"field_750-4-47837\" value=\"340\" data-label=\"Pediatrics - Dr \/ NP (340$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"750\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"750\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_750-4-47837\" aria-label=\"Pediatrics - Dr \/ NP (340$)\">Pediatrics - Dr \/ NP (340$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[750]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_751_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_751\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_s9nx3w_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >ADHD<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_751-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[751][]\" data-type=\"checkbox\" id=\"field_751-0-47837\" value=\"400\" data-label=\"New evaluation (400$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"751\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"751\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_751-0-47837\" aria-label=\"New evaluation (400$)\">New evaluation (400$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_751-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[751][]\" data-type=\"checkbox\" id=\"field_751-1-47837\" value=\"425\" data-label=\"Treatment plan (425$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"751\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"751\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_751-1-47837\" aria-label=\"Treatment plan (425$)\">Treatment plan (425$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_751-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[751][]\" data-type=\"checkbox\" id=\"field_751-2-47837\" value=\"475\" data-label=\"Treatment plan with external eval (475$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"751\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"751\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_751-2-47837\" aria-label=\"Treatment plan with external eval (475$)\">Treatment plan with external eval (475$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_751-3\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[751][]\" data-type=\"checkbox\" id=\"field_751-3-47837\" value=\"165\" data-label=\"Follow up with Dr. (165$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"751\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"751\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_751-3-47837\" aria-label=\"Follow up with Dr. (165$)\">Follow up with Dr. (165$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_751-4\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[751][]\" data-type=\"checkbox\" id=\"field_751-4-47837\" value=\"270\" data-label=\"Annual medication renewal  (270$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"751\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"751\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_751-4-47837\" aria-label=\"Annual medication renewal  (270$)\">Annual medication renewal  (270$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[751]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_752_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_752\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_d9iel1_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Mental health<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_752-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[752][]\" data-type=\"checkbox\" id=\"field_752-0-47837\" value=\"340\" data-label=\"Initial appointment (340$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"752\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"752\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_752-0-47837\" aria-label=\"Initial appointment (340$)\">Initial appointment (340$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_752-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[752][]\" data-type=\"checkbox\" id=\"field_752-1-47837\" value=\"225\" data-label=\"Follow up 15 (225$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"752\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"752\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_752-1-47837\" aria-label=\"Follow up 15 (225$)\">Follow up 15 (225$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_752-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[752][]\" data-type=\"checkbox\" id=\"field_752-2-47837\" value=\"270\" data-label=\"Follow Up 30 (270$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"752\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"752\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_752-2-47837\" aria-label=\"Follow Up 30 (270$)\">Follow Up 30 (270$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_752-3\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[752][]\" data-type=\"checkbox\" id=\"field_752-3-47837\" value=\"340\" data-label=\"Mental Health Major (340$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"752\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"752\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_752-3-47837\" aria-label=\"Mental Health Major (340$)\">Mental Health Major (340$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[752]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_753_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_753\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_29d69r_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Hemato-Oncology<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_753-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[753][]\" data-type=\"checkbox\" id=\"field_753-0-47837\" value=\"475\" data-label=\"Initial appointment (475$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"753\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"753\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_753-0-47837\" aria-label=\"Initial appointment (475$)\">Initial appointment (475$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_753-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[753][]\" data-type=\"checkbox\" id=\"field_753-1-47837\" value=\"280\" data-label=\"Follow up (280$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"753\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"753\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_753-1-47837\" aria-label=\"Follow up (280$)\">Follow up (280$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[753]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_755_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_755\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_he48l8_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >TDAH Laval\/Laurentides clinic (Dre Bonnaud)<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-0-47837\" value=\"445\" data-label=\"Child - First appointment with the Nurse ($445)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-0-47837\" aria-label=\"Child - First appointment with the Nurse ($445)\">Child - First appointment with the Nurse ($445)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-1-47837\" value=\"565\" data-label=\"Child - Second appointment with the Doctor ($565)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-1-47837\" aria-label=\"Child - Second appointment with the Doctor ($565)\">Child - Second appointment with the Doctor ($565)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-2-47837\" value=\"70\" data-label=\"Adult - First appointment with the Nurse ($70)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-2-47837\" aria-label=\"Adult - First appointment with the Nurse ($70)\">Adult - First appointment with the Nurse ($70)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-3\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-3-47837\" value=\"395\" data-label=\"Adult - Second appointment with the Nurse ($395)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-3-47837\" aria-label=\"Adult - Second appointment with the Nurse ($395)\">Adult - Second appointment with the Nurse ($395)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-4\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-4-47837\" value=\"565\" data-label=\"Adult - Third appointment with the Doctor ($565)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-4-47837\" aria-label=\"Adult - Third appointment with the Doctor ($565)\">Adult - Third appointment with the Doctor ($565)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-5\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-5-47837\" value=\"190\" data-label=\"Clinical reassessment of ADHD medication with the Nurse ($190)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-5-47837\" aria-label=\"Clinical reassessment of ADHD medication with the Nurse ($190)\">Clinical reassessment of ADHD medication with the Nurse ($190)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-6\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-6-47837\" value=\"565\" data-label=\"Clinical reassessment of ADHD medication with the Doctor ($565)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-6-47837\" aria-label=\"Clinical reassessment of ADHD medication with the Doctor ($565)\">Clinical reassessment of ADHD medication with the Doctor ($565)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-7\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-7-47837\" value=\"105\" data-label=\"Medication monitoring with the Nurse ($105)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-7-47837\" aria-label=\"Medication monitoring with the Nurse ($105)\">Medication monitoring with the Nurse ($105)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-8\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-8-47837\" value=\"165\" data-label=\"Medication monitoring with the Doctor ($165)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-8-47837\" aria-label=\"Medication monitoring with the Doctor ($165)\">Medication monitoring with the Doctor ($165)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_755-9\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[755][]\" data-type=\"checkbox\" id=\"field_755-9-47837\" value=\"270\" data-label=\"12 months medication monitoring with the Doctor ($270)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"755\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"755\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_755-9-47837\" aria-label=\"12 months medication monitoring with the Doctor ($270)\">12 months medication monitoring with the Doctor ($270)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[755]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_770_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_770\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_ugj72t_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Urology<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_770-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[770][]\" data-type=\"checkbox\" id=\"field_770-0-47837\" value=\"470\" data-label=\"Initial consultation (470$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"770\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"770\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_770-0-47837\" aria-label=\"Initial consultation (470$)\">Initial consultation (470$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_770-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[770][]\" data-type=\"checkbox\" id=\"field_770-1-47837\" value=\"255\" data-label=\"Follow-up (255$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"770\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"770\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_770-1-47837\" aria-label=\"Follow-up (255$)\">Follow-up (255$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[770]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_764_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_vertical_radio  arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_764\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_511fns_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Other fees<\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_764-0\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[764][]\" data-type=\"checkbox\" id=\"field_764-0-47837\" value=\"40\" data-label=\"Additionnal appointment fee : Weekend, evening and holidays (40$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"764\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"764\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_764-0-47837\" aria-label=\"Additionnal appointment fee : Weekend, evening and holidays (40$)\">Additionnal appointment fee : Weekend, evening and holidays (40$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_764-1\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[764][]\" data-type=\"checkbox\" id=\"field_764-1-47837\" value=\"103.48\" data-label=\"Form fee (103.48$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"764\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"764\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_764-1-47837\" aria-label=\"Form fee (103.48$)\">Form fee (103.48$)<\/label><\/div><div class=\"arf_checkbox_style \" id=\"frm_checkbox_764-2\"><div class='arf_checkbox_input_wrapper  arf_checkbox_separate_value '><input type=\"checkbox\" name=\"item_meta[764][]\" data-type=\"checkbox\" id=\"field_764-2-47837\" value=\"5.75\" data-label=\"additional page fee (5.75$)\"    style=''  onChange='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"764\",[758]);},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"764\",[758]);' \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_764-2-47837\" aria-label=\"additional page fee (5.75$)\">additional page fee (5.75$)<\/label><\/div><input type='hidden' class='arf_label_checkbox_hidden' name='_item_meta[764]' \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_757_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_757\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_8ulbii_47837\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Special amount<\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_8ulbii_47837\"  name=\"item_meta[757]\"  onkeyup='clearTimeout(__arf_timeout_handle); __arf_timeout_handle = setTimeout(function(){arf_calculate_total(\"ngdjtp\",\"757\",[758])},100);' data-arf-keyup='arf_calculate_total(\"ngdjtp\",\"757\",[758]);'   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_758_47837_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_758\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><span style=\"font-size:20px\">\n    Total: \n    <div id=\"arf_running_total_758\" class=\"arf_running_total\" data-arfcalc=\"\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+  \n        0+\n        0+\n        0+\n        0+\n        0+\n   0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n        0+\n0+\n0+\n        0+\n        0+\n        0+   \n        0+  \n        0\n    \" data-round=\"0\" aria-label=\"\">&nbsp;<\/div> \n    $<\/span><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_759_47837_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_759\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><p>**The amount paid here represents the amount assessed according to the initial reason for consultation mentioned. Please note that additional fees may apply depending on the progress of the consultation.<\/p>\n\n<p>You will be redirected to Secure PayPal to proceed with online payment, you can pay by credit card without having an account. A detailed invoice will be sent to you following your consultation.<\/p>\n\n<img decoding=\"async\" src=\"https:\/\/excellemd.com\/wp-content\/uploads\/arforms\/1590162752924_paypalsecuredfr.png\" style=\"height:100px\" alt=\"\"><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_760_47837_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_760\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_760-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[760][]\" data-type=\"checkbox\" id=\"field_760-0-47837\" value=\"I understand and agree with the terms\" data-label=\"I understand and agree with the terms\"    class=\" arf_required 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