{"id":7705,"date":"2021-12-21T21:08:39","date_gmt":"2021-12-21T20:08:39","guid":{"rendered":"https:\/\/excellemd.com\/transfertdossier\/"},"modified":"2021-12-21T23:29:32","modified_gmt":"2021-12-21T22:29:32","slug":"filetransfer","status":"publish","type":"page","link":"https:\/\/excellemd.com\/en\/filetransfer\/","title":{"rendered":"Medical File Transfer Request"},"content":{"rendered":"<p>[vc_row][vc_column]<style type=\"text\/css\" id=\"106\" data-form-unique-id=\"35002\" ><\/style><div class=\"arf_form ar_main_div_106 arf_form_outer_wrapper \" id=\"arffrm_106_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\">Form is successfully submitted. Thank you!<\/div><\/div><\/div><form enctype=\"multipart\/form-data\" method=\"post\" class=\"arfshowmainform  \" style=\"\" data-form-id=\"form_1dwfzv\"  novalidate=\"\" onsubmit=\"return arf_validate_form_submit()\" arf_form_submit = 0 data-id=\"35002\"  data-random-id=\"106_QMqgQ0nj4H\"  data-submission-key=\"ISzDLx21\"  data-key-validate=\"false\"  data-popup-id=\"\"><label for='arf_filter_input_106_QMqgQ0nj4H' class='arf_hidden_element' style='color:transparent !important;'>Filter<\/label><input id='arf_filter_input_106_QMqgQ0nj4H' type='text' name='arf_filter_input' data-jqvalidate='false' data-random-key='106_QMqgQ0nj4H' 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=\"1777280994\" \/><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=\"cccfe5ec6a\" \/><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=\"e002ba697f\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfdecimal_separator\" data-id=\"arfdecimal_separator\" value=\".\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfform_date_formate_106\" data-id=\"arfform_date_formate_106\" value=\"MMM D, YYYY\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key_106\" data-id=\"form_key_106\" value=\"1dwfzv\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_success_message_show_time_106\" data-id=\"arf_success_message_show_time_106\" value=\"3\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_hide_after_submit_106\" data-id=\"arf_form_hide_after_submit_106\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"is_form_preview_106\" data-id=\"is_form_preview_106\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_validate_outside_106\" data-id=\"arf_validate_outside_106\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_validate_outside_106\" data-id=\"arf_is_validate_outside_106\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_aftersubmit_106\" data-id=\"arf_is_resetform_aftersubmit_106\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_outside_106\" data-id=\"arf_is_resetform_outside_106\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_enable_cookie_106\" data-id=\"arf_form_enable_cookie_106\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_tooltip_settings_106\" data-id=\"arf_tooltip_settings_106\" class=\"arf_front_tooltip_settings\" data-form-id=\"106\" data-color=\"#FFFFFF\" data-position=\"top\" data-width=\"\" data-bg-color=\"#000000\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfsuccessmsgposition_106\" data-id=\"arfsuccessmsgposition_106\"  value=\"top\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakstyle_106\" data-id=\"arfpagebreakstyle_106\"  value=\"number\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakaddtimer_106\" data-id=\"arfpagebreakaddtimer_106\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_tooltip_error_106\" data-id=\"form_tooltip_error_106\" data-color=\"\" data-position=\"bottom\" value=\"normal\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfaction\" value=\"create\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_id\" data-id=\"form_id\" value=\"106\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_data_id\" data-id=\"form_data_id\" value=\"35002\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key\" data-id=\"form_key\" value=\"1dwfzv\" \/><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\/filetransfer\/\" \/><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-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_duration_front_106' name='arf_pb_field_animation_duration_front_106' value='' \/><input type='hidden' id='arf_pb_field_animation_delay_front_106' name='arf_pb_field_animation_delay_front_106' value='' \/><input type='hidden' id='arf_pb_field_animation_inherit_106' name='arf_pb_field_animation_inherit_106' value='0' \/><input type='hidden' id='arf_field_animation_style_front_106' name='arf_field_animation_style_front_106' value='' \/><input type='hidden' id='arf_field_animation_duration_front_106' name='arf_field_animation_duration_front_106' value='' \/><input type='hidden' id='arf_field_animation_delay_front_106' name='arf_field_animation_delay_front_106' value='' \/><input type=\"hidden\" id=\"arf_form_site_wide_106\" value=\"no\" \/><div class=\"allfields\" ><div class=\"arf_fieldset arf_materialize_form\" id=\"arf_fieldset_35002\"><div class=\"arftitlecontainer\"><div class=\"formtitle_style\">Medical File Transfer Request<\/div><\/div><div id=\"page_0\" class=\"page_break\"><div id=\"arf_field_441_35002_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_441\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><p>\nI, the undersigned or the authorized person (if the patient is younger than 14 years old) authorizes the establishment below to send to ExcelleMD Private Clinics a complete copy of my file. Thank you in advance for your attention to my request and please accept my best regards.\n<\/p><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_442_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_442\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_qhrdei_35002\"  name=\"item_meta[442]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_qhrdei_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Firstname<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_443_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_443\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_w7qeml_35002\"  name=\"item_meta[443]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_w7qeml_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Lastname<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_444_35002_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_444\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_4iocd1_35002\"  name=\"item_meta[444]\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_4iocd1_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >First and lastname of the representative (if the patient is younger than 14 years old)<\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_460_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_460\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_5ut4lv_35002\"  name=\"item_meta[460]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_5ut4lv_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Medical facility owning my file<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_461_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_461\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_jtj3iv_35002\"  name=\"item_meta[461]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_jtj3iv_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Doctor<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_445_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_date  top_container  top_container arfformfield  arf_field_445\"  style='width: 100%'  data-field-type=\"date\" data-parent_field=\"0\"><div class=\"controls arf_date_main_controls \"   ><div class=\"arf_material_theme_container  \"><input type=\"text\" data-date-format=\"MMM D, YYYY\" data-start-date=\"01\/01\/1876 00:00 AM\" data-cl-format=\"YYYY-MM-DD\" data-date-new-format=\"MM\/DD\/YYYY\" data-end-date=\"12\/31\/2076 11:59 PM\" data-default-date=\"\" id=\"field_eehuw2_35002\"    class=\" arf_required frm_date arforms_datepicker_control\" data-name='item_meta[445]' data-format='MMM D, YYYY' data-field-options=\"{&quot;required&quot;:&quot;1&quot;,&quot;required_indicator&quot;:&quot;*&quot;,&quot;blank&quot;:&quot;This field cannot be blank.&quot;,&quot;field_width&quot;:&quot;&quot;,&quot;locale&quot;:&quot;en&quot;,&quot;currentdefaultdate&quot;:&quot;&quot;,&quot;name&quot;:&quot;Date of birth&quot;,&quot;default_value&quot;:&quot;&quot;,&quot;description&quot;:&quot;&quot;,&quot;placeholdertext&quot;:&quot;&quot;,&quot;show_time_calendar&quot;:&quot;&quot;,&quot;frm_show_time_calendar_field_indicator&quot;:&quot;&quot;,&quot;clock&quot;:&quot;12&quot;,&quot;step&quot;:&quot;30&quot;,&quot;off_days&quot;:&quot;&quot;,&quot;start_date&quot;:&quot;&quot;,&quot;end_date&quot;:&quot;&quot;,&quot;arf_show_min_current_date&quot;:&quot;0&quot;,&quot;arf_show_max_current_date&quot;:&quot;0&quot;,&quot;arf_tooltip&quot;:&quot;&quot;,&quot;frm_arf_tooltip_field_indicator&quot;:&quot;&quot;,&quot;tooltip_text&quot;:&quot;&quot;,&quot;enable_arf_prefix&quot;:&quot;&quot;,&quot;arf_prefix_icon&quot;:&quot;&quot;,&quot;enable_arf_suffix&quot;:&quot;&quot;,&quot;arf_suffix_icon&quot;:&quot;&quot;,&quot;classes&quot;:&quot;arf_1&quot;,&quot;inner_class&quot;:&quot;arf_1col&quot;,&quot;key&quot;:&quot;eehuw2&quot;,&quot;selectdefaultdate&quot;:&quot;&quot;,&quot;arfnewdateformat&quot;:&quot;&quot;,&quot;css_outer_wrapper&quot;:&quot;&quot;,&quot;css_label&quot;:&quot;&quot;,&quot;css_input_element&quot;:&quot;&quot;,&quot;css_description&quot;:&quot;&quot;,&quot;css_add_icon&quot;:&quot;&quot;,&quot;type&quot;:&quot;date&quot;,&quot;arf_enable_readonly&quot;:&quot;0&quot;,&quot;image_position_from&quot;:&quot;top_left&quot;,&quot;clear_on_focus&quot;:0,&quot;default_blank&quot;:0,&quot;arf_regular_expression&quot;:&quot;&quot;}\" data-validation-required-message=\"This field cannot be blank.\" \/><input type=\"hidden\" name=\"item_meta[445]\" id=\"field_eehuw2_35002_formatted\" \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"date\" for=\"field_eehuw2_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Date of birth<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_446_35002_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_446\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_68f4ua_35002\"  name=\"item_meta[446]\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_68f4ua_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >RAMQ<\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_447_35002_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_447\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_emnnqn_35002\"  name=\"item_meta[447]\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_emnnqn_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >RAMQ expiration<\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_448_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_448\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_7ri3j1_35002\"  name=\"item_meta[448]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_7ri3j1_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Address<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_449_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_449\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_x4ju4r_35002\"  name=\"item_meta[449]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_x4ju4r_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >City<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_452_35002_container\" class=\"    arfformfield input-field control-group arfmainformfield  arffieldrequired arf_field_type_select  top_container  top_container arfformfield  arf_field_452\"  style='width: 100%'  data-field-type=\"select\" data-parent_field=\"0\"><div class=\" sltstandard_front controls\"  ><div class=\"arf_material_theme_container arf_material_active_container_open\"><div class=\"arf_selectpicker_wrapper\" style=\"min-width:100px; \"><input type=\"text\" autocomplete=\"off\" class=\"arf-selectpicker-input-control \" id=\"field_7xadf4_35002\" name=\"item_meta[452]\" value=\"Alberta,\"  data-default-val='Alberta,'  data-validation-required-message='This field cannot be blank.'  data-field_id='452' ><dl class=\"arf-selectpicker-control  arf_form_field_picker \" data-id=\"field_7xadf4_35002\" data-name=\"item_meta[452]\"><dt><span>Alberta, <\/span><i class=\"arf-selectpicker-caret\"><\/i><\/dt><dd><ul data-id=\"field_7xadf4_35002\" id=\"\" class=\"\"><li class=\"\" data-pos=\"0\" aria-label=\"Alberta,\"  data-value=\"Alberta,\" data-label=\"Alberta,\">Alberta,<\/li><li class=\"\" data-pos=\"1\" aria-label=\"British Columbia,\"  data-value=\"British Columbia,\" data-label=\"British Columbia,\">British Columbia,<\/li><li class=\"\" data-pos=\"2\" aria-label=\"Manitoba,\"  data-value=\"Manitoba,\" data-label=\"Manitoba,\">Manitoba,<\/li><li class=\"\" data-pos=\"3\" aria-label=\"New Brunswick,\"  data-value=\"New Brunswick,\" data-label=\"New Brunswick,\">New Brunswick,<\/li><li class=\"\" data-pos=\"4\" aria-label=\"Northwest Territories,\"  data-value=\"Northwest Territories,\" data-label=\"Northwest Territories,\">Northwest Territories,<\/li><li class=\"\" data-pos=\"5\" aria-label=\"Nova Scotia,\"  data-value=\"Nova Scotia,\" data-label=\"Nova Scotia,\">Nova Scotia,<\/li><li class=\"\" data-pos=\"6\" aria-label=\"Nunavut,\"  data-value=\"Nunavut,\" data-label=\"Nunavut,\">Nunavut,<\/li><li class=\"\" data-pos=\"7\" aria-label=\"Ontario,\"  data-value=\"Ontario,\" data-label=\"Ontario,\">Ontario,<\/li><li class=\"\" data-pos=\"8\" aria-label=\"Prince Edward Island,\"  data-value=\"Prince Edward Island,\" data-label=\"Prince Edward Island,\">Prince Edward Island,<\/li><li class=\"\" data-pos=\"9\" aria-label=\"Quebec,\"  data-value=\"Quebec,\" data-label=\"Quebec,\">Quebec,<\/li><li class=\"\" data-pos=\"10\" aria-label=\"Saskatchewan,\"  data-value=\"Saskatchewan,\" data-label=\"Saskatchewan,\">Saskatchewan,<\/li><li class=\"\" data-pos=\"11\" aria-label=\"Yukon\"  data-value=\"Yukon\" data-label=\"Yukon\">Yukon<\/li><\/ul><\/dd><\/dl><\/div><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch\"><label data-type=\"select\" for=\"field_7xadf4_35002\" class=\"arf_main_label arf_main_label_16px active \" aria-label = >Province<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_451_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_451\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input   type=\"text\" id=\"field_xxj9io_35002\"  name=\"item_meta[451]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"text\" for=\"field_xxj9io_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Zip code<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_453_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_phone  top_container  top_container arfformfield   arf_inline_field_value  arf_field_453\"  style='width: 100%'  data-field-type=\"phone\" data-parent_field=\"0\"><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input type=\"text\" data-type=\"phone\"  id=\"field_8384iz_35002\"name=\"item_meta[453]\" class=\" arf_required \"data-validation-required-message=\"This field cannot be blank.\"data-validation-number-message=\"Phone is invalid\"\/><div class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"phone\" for=\"field_8384iz_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Phone<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_454_35002_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_email  top_container  arf_inline_field_value   top_container arfformfield  arf_field_454\"  style='width: 100%'  data-field-type=\"email\" data-parent_field=\"0\"><div class=\"controls\"   ><div class=\"arf_material_theme_container  \"><input type=\"text\" id=\"field_dkq59w_35002\" name=\"item_meta[454]\"  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 class=\"arf_material_standard\"><div class=\"arf_material_theme_prefix\"><\/div><div class=\"arf_material_theme_notch \"><label data-type=\"email\" for=\"field_dkq59w_35002\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Email<span class=\"arfcheckrequiredfield\">*<\/span><\/label><\/div><div class=\"arf_material_theme_suffix\"><\/div><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_455_35002_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container arfformfield  top_container arf_field_455\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><div class=\"setting_checkbox controls  arf_material_checkbox arf_default_material \" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style  \" id=\"frm_checkbox_455-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[455][]\" data-type=\"checkbox\" id=\"field_455-0-35002\" value=\"I read and I accept that we transfer my entire medical file\" data-label=\"I read and I accept that we transfer my entire medical file\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_455-0-35002\" aria-label=\"I read and I accept that we transfer my entire medical file\">I read and I accept that we transfer my entire medical file<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_456_35002_container\" class=\"     arfformfield control-group arfmainformfield input-field  arffieldrequired arf_field_type_signature  top_container  top_container arfformfield  arf_field_456\"  style='width: 100%' data-field-type=\"signature\" data-parent_field=\"0\"><\/div><div style=\"clear:both;\"><\/div><div style=\"clear:both;height:1px;\">&nbsp;<\/div><\/div><!-- page_break && page_0--><div class=\"arfsubmitbutton top_container\" ><div class=\"arf_submit_div file-field  top_container\"><input type=\"hidden\" data-jqvalidate=\"false\" value=\"1\" name=\"is_submit_form_106\" data-id=\"is_submit_form_106\" \/><input type=\"hidden\" data-jqvalidate=\"false\" value=\"0\" data-val=\"0\" data-max=\"0\" name=\"submit_form_106\" data-id=\"submit_form_106\" \/><button class=\"arf_submit_btn  arf_submit_btn_border btn btn-flat  btn-info arfstyle-button  unknown\"  id=\"arf_submit_btn_35002\" name=\"arf_submit_btn_35002\" data-style=\"zoom-in\"  ><span class=\"arfsubmitloader\"><\/span><span class=\"arfstyle-label\">Submit<\/span><\/button><\/div><\/div><div style=\"clear:both\"><\/div><\/div><!-- arf_fieldset --><\/div><!-- allfields --><\/form><script type='text\/javascript' data-cfasync='false'>if(!window['arf_conditional_logic']){window['arf_conditional_logic'] = new Array();}window['arf_conditional_logic'][35002] = {\"logic\":[],\"dependents\":[],\"defaults\":[]};if(!window['arf_pages_fields']){window['arf_pages_fields'] = new Array();}window['arf_pages_fields'][35002] = [{\"field_id\":\"441\",\"field_key\":\"d5zfim\",\"default_value\":\"\",\"field_type\":\"html\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"442\",\"field_key\":\"qhrdei\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"443\",\"field_key\":\"w7qeml\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"444\",\"field_key\":\"4iocd1\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"460\",\"field_key\":\"5ut4lv\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"461\",\"field_key\":\"jtj3iv\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"445\",\"field_key\":\"eehuw2\",\"default_value\":\"\",\"field_type\":\"date\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"446\",\"field_key\":\"68f4ua\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"447\",\"field_key\":\"emnnqn\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"448\",\"field_key\":\"7ri3j1\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"449\",\"field_key\":\"x4ju4r\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"452\",\"field_key\":\"7xadf4\",\"default_value\":\"Alberta,\",\"field_type\":\"select\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"451\",\"field_key\":\"xxj9io\",\"default_value\":\"\",\"field_type\":\"text\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"453\",\"field_key\":\"8384iz\",\"default_value\":\"\",\"field_type\":\"phone\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"454\",\"field_key\":\"dkq59w\",\"default_value\":\"\",\"field_type\":\"email\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"455\",\"field_key\":\"f1kpyt\",\"default_value\":[],\"field_type\":\"checkbox\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0},{\"field_id\":\"456\",\"field_key\":\"8cliej\",\"default_value\":\"\",\"field_type\":\"signature\",\"page_no\":0,\"heading_id\":0,\"repeater_id\":0}];<\/script><\/div><!--arf_form_outer_wrapper --><div class=\"brand-div\"><\/div><div class=\"\"><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_id\" data-id=\"form_id\" value=\"106\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfmainformurl\" data-id=\"arfmainformurl\" value=\"https:\/\/excellemd.com\/wp-content\/plugins\/arforms\" \/><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":15,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","footnotes":""},"class_list":["post-7705","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medical File Transfer Request - Excelle MD<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/excellemd.com\/en\/filetransfer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medical File Transfer Request - Excelle MD\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/excellemd.com\/en\/filetransfer\/\" \/>\n<meta property=\"og:site_name\" content=\"Excelle MD\" \/>\n<meta property=\"article:modified_time\" content=\"2021-12-21T22:29:32+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/excellemd.com\\\/en\\\/filetransfer\\\/\",\"url\":\"https:\\\/\\\/excellemd.com\\\/en\\\/filetransfer\\\/\",\"name\":\"Medical File Transfer Request - Excelle MD\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/excellemd.com\\\/#website\"},\"datePublished\":\"2021-12-21T20:08:39+00:00\",\"dateModified\":\"2021-12-21T22:29:32+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/excellemd.com\\\/en\\\/filetransfer\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/excellemd.com\\\/en\\\/filetransfer\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/excellemd.com\\\/en\\\/filetransfer\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\\\/\\\/excellemd.com\\\/en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Medical File Transfer Request\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/excellemd.com\\\/#website\",\"url\":\"https:\\\/\\\/excellemd.com\\\/\",\"name\":\"Excelle MD\",\"description\":\"une clinique priv\u00e9e, qui offre \u00e0 leur client\u00e8le des soins m\u00e9dicaux rapides d\u2019acc\u00e8s\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/excellemd.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Medical File Transfer Request - Excelle MD","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/excellemd.com\/en\/filetransfer\/","og_locale":"en_US","og_type":"article","og_title":"Medical File Transfer Request - Excelle MD","og_description":"[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row]","og_url":"https:\/\/excellemd.com\/en\/filetransfer\/","og_site_name":"Excelle MD","article_modified_time":"2021-12-21T22:29:32+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/excellemd.com\/en\/filetransfer\/","url":"https:\/\/excellemd.com\/en\/filetransfer\/","name":"Medical File Transfer Request - Excelle MD","isPartOf":{"@id":"https:\/\/excellemd.com\/#website"},"datePublished":"2021-12-21T20:08:39+00:00","dateModified":"2021-12-21T22:29:32+00:00","breadcrumb":{"@id":"https:\/\/excellemd.com\/en\/filetransfer\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/excellemd.com\/en\/filetransfer\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/excellemd.com\/en\/filetransfer\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"https:\/\/excellemd.com\/en\/"},{"@type":"ListItem","position":2,"name":"Medical File Transfer Request"}]},{"@type":"WebSite","@id":"https:\/\/excellemd.com\/#website","url":"https:\/\/excellemd.com\/","name":"Excelle MD","description":"une clinique priv\u00e9e, qui offre \u00e0 leur client\u00e8le des soins m\u00e9dicaux rapides d\u2019acc\u00e8s","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/excellemd.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"taxonomy_info":[],"featured_image_src_large":false,"author_info":{"display_name":"Vikrant Datta","author_link":"https:\/\/excellemd.com\/en\/author\/vikrant-dattawell-company\/"},"comment_info":0,"_links":{"self":[{"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/pages\/7705","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/comments?post=7705"}],"version-history":[{"count":1,"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/pages\/7705\/revisions"}],"predecessor-version":[{"id":7706,"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/pages\/7705\/revisions\/7706"}],"wp:attachment":[{"href":"https:\/\/excellemd.com\/en\/wp-json\/wp\/v2\/media?parent=7705"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}