{"id":9416,"date":"2021-09-28T12:54:59","date_gmt":"2021-09-28T10:54:59","guid":{"rendered":"https:\/\/beautysane.com\/be\/bodycheck"},"modified":"2022-10-16T14:34:03","modified_gmt":"2022-10-16T12:34:03","slug":"bodycheck","status":"publish","type":"page","link":"https:\/\/beautysane.com\/be\/nl\/bodycheck","title":{"rendered":"BodyCheck"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'><div id='gf_4' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; geeft vereiste velden aan<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_4' id='gform_4'  action='\/be\/nl\/wp-json\/wp\/v2\/pages\/9416#gf_4' data-formid='4' novalidate><ul class=\"container custom_progress_steps\"><li class=\"step_1 active\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_1.svg\" alt=\"\"><\/li><li class=\"step_2\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_2.svg\" alt=\"\"><\/li><li class=\"step_3\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_3.svg\" alt=\"\"><\/li><li class=\"step_4\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_4.svg\" alt=\"\"><\/li><li class=\"step_5\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_5.svg\" alt=\"\"><\/li><li class=\"step_6\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_6.svg\" alt=\"\"><\/li><li class=\"step_7\"><img src=\"https:\/\/beautysane.com\/be\/wp-content\/themes\/storefront-child\/assets\/images\/bodycheck\/step_7.svg\" alt=\"\"><\/li><\/ul><div class=\"title_backgrounds_container\"><p class=\"title\">BodyCheck<span>by Beautysan\u00e9<\/span><\/p><div class=\"backgrounds woman\"><div class='womens_photo' style='background-image: url(\"https:\/\/beautysane.ams3.digitaloceanspaces.com\/wp-content\/uploads\/sites\/4\/2021\/09\/29034202\/bodycheck_femme.jpeg\")'><\/div><div class='mans_photo' style='background-image: url(\"https:\/\/beautysane.ams3.digitaloceanspaces.com\/wp-content\/uploads\/sites\/4\/2021\/09\/29034202\/bodycheck_homme.jpg\")'><\/div><img class=\"image_b\" src=\"https:\/\/beautysane.ams3.digitaloceanspaces.com\/wp-content\/uploads\/sites\/4\/2021\/09\/29034204\/bc_image_b.svg\" alt=\"\"><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_4_1' class='gform_page ' data-js='page-field-id-0' >\n                                    <div class='gform_page_fields'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_74\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_74\" ><div class='ginput_container ginput_container_text'><input name='input_74' id='input_4_74' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='1' \/><\/div><\/div><div id=\"field_4_69\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_69\" ><div class='ginput_container ginput_container_text'><input name='input_69' id='input_4_69' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/div><div id=\"field_4_70\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_70\" ><div class='ginput_container ginput_container_text'><input name='input_70' id='input_4_70' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/div><div id=\"field_4_72\" class=\"gfield gfield--type-email gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_72\" ><label class='gfield_label gform-field-label' for='input_4_72'>E-mail Sponsor<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_72' id='input_4_72' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_75\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_75\" ><div class='ginput_container ginput_container_text'><input name='input_75' id='input_4_75' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/div><div id=\"field_4_2\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\" >Faisons connaissance<\/div><fieldset id=\"field_4_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full civility_choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_3\" ><legend class='gfield_label gform-field-label' >Vous \u00eates<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_3'>\n\t\t\t<div class='gchoice gchoice_4_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='[A] Un homme'  id='choice_4_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_3_0' id='label_4_3_0' class='gform-field-label gform-field-label--type-inline'>Un homme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='[B] Une femme'  id='choice_4_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_3_1' id='label_4_3_1' class='gform-field-label gform-field-label--type-inline'>Une femme<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_4\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_4\" ><label class='gfield_label gform-field-label' for='input_4_4'>Votre \u00e2ge<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_4' id='input_4_4' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_5\" ><label class='gfield_label gform-field-label' for='input_4_5'>Votre taille<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_5' id='input_4_5' type='number' step='any'   value='' class='large'    placeholder='en cm (ex: 175)' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_6\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_6\" ><label class='gfield_label gform-field-label' for='input_4_6'>Votre poids<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_4_6' type='number' step='any'   value='' class='large'    placeholder='en kg (ex:65)' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_4_7\" class=\"gfield gfield--type-text gfield--width-full grid_width_6 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_7\" ><label class='gfield_label gform-field-label' for='input_4_7'>Votre pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_73\" class=\"gfield gfield--type-text gfield--width-full grid_width_6 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_73\" ><label class='gfield_label gform-field-label' for='input_4_73'>Votre nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_4_73' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_2' class='gform_page' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_8\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_8\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_9\" ><legend class='gfield_label gform-field-label' >Combien consommez-vous de portions de f\u00e9culents (p\u00e2tes, riz, pommes de terre, l\u00e9gumes secs&#8230;) ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_9'>\n\t\t\t<div class='gchoice gchoice_4_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='[A] 3 portions ou plus par jour'  id='choice_4_9_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_9\"   \/>\n\t\t\t\t\t<label for='choice_4_9_0' id='label_4_9_0' class='gform-field-label gform-field-label--type-inline'>3 portions ou plus par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='[B] 2 \u00e0 3 portions par jour'  id='choice_4_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_9_1' id='label_4_9_1' class='gform-field-label gform-field-label--type-inline'>2 \u00e0 3 portions par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='[C] Moins d&#039;1 fois par jour'  id='choice_4_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_9_2' id='label_4_9_2' class='gform-field-label gform-field-label--type-inline'>Moins d&#8217;1 fois par jour<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_9'>(1 portion = 1\/3 assiette)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_3' class='gform_page' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_18\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_18\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_10\" ><legend class='gfield_label gform-field-label' >Combien consommez-vous de portions de l\u00e9gumes ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_10'>\n\t\t\t<div class='gchoice gchoice_4_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='[A] 3 portions ou plus par jour'  id='choice_4_10_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_10\"   \/>\n\t\t\t\t\t<label for='choice_4_10_0' id='label_4_10_0' class='gform-field-label gform-field-label--type-inline'>3 portions ou plus par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='[B] 1 \u00e0 2 portions par jour'  id='choice_4_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_10_1' id='label_4_10_1' class='gform-field-label gform-field-label--type-inline'>1 \u00e0 2 portions par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='[C] Moins de 5 fois par semaine'  id='choice_4_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_10_2' id='label_4_10_2' class='gform-field-label gform-field-label--type-inline'>Moins de 5 fois par semaine<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_10'>(1 portion = 1\/3 assiette)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_4' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_20\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_20\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_11\" ><legend class='gfield_label gform-field-label' >Combien consommez-vous de prot\u00e9ines (viande, poisson, oeufs, l\u00e9gumes secs) ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_11'>\n\t\t\t<div class='gchoice gchoice_4_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='[A] 2 portions ou plus par jour'  id='choice_4_11_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_11\"   \/>\n\t\t\t\t\t<label for='choice_4_11_0' id='label_4_11_0' class='gform-field-label gform-field-label--type-inline'>2 portions ou plus par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='[B] 1 portion par jour'  id='choice_4_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_11_1' id='label_4_11_1' class='gform-field-label gform-field-label--type-inline'>1 portion par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='[C] Moins de 3 fois par semaine'  id='choice_4_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_11_2' id='label_4_11_2' class='gform-field-label gform-field-label--type-inline'>Moins de 3 fois par semaine<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_11'>(1 portion = 1\/3 assiette)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_5' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_22\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_22\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_12\" ><legend class='gfield_label gform-field-label' >Combien consommez-vous de produits laitiers ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_12'>\n\t\t\t<div class='gchoice gchoice_4_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='[A] 3 portions ou plus par jour'  id='choice_4_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_0' id='label_4_12_0' class='gform-field-label gform-field-label--type-inline'>3 portions ou plus par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='[B] 1 \u00e0 2 portions par jour'  id='choice_4_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_1' id='label_4_12_1' class='gform-field-label gform-field-label--type-inline'>1 \u00e0 2 portions par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='[C] Moins de 5 fois par semaine'  id='choice_4_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_2' id='label_4_12_2' class='gform-field-label gform-field-label--type-inline'>Moins de 5 fois par semaine<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_6' class='gform_page' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_24\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_24\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_13\" ><legend class='gfield_label gform-field-label' >Combien consommez-vous de portions de fruits ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_13'>\n\t\t\t<div class='gchoice gchoice_4_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='[A] 2 portions ou plus par jour'  id='choice_4_13_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_13\"   \/>\n\t\t\t\t\t<label for='choice_4_13_0' id='label_4_13_0' class='gform-field-label gform-field-label--type-inline'>2 portions ou plus par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='[B] 1 portion par jour'  id='choice_4_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_13_1' id='label_4_13_1' class='gform-field-label gform-field-label--type-inline'>1 portion par jour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='[C] Moins de 5 fois par semaine'  id='choice_4_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_13_2' id='label_4_13_2' class='gform-field-label gform-field-label--type-inline'>Moins de 5 fois par semaine<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_13'>(1 portion = 1 poign\u00e9e ou 1 compote)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_25' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_7' class='gform_page' data-js='page-field-id-25' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_26\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_26\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_14\" ><legend class='gfield_label gform-field-label' >Quelle est votre consommation de produits gras (charcuteries, fritures, viennoiseries&#8230;) ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_14'>\n\t\t\t<div class='gchoice gchoice_4_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='[A] Moins d&#039;une fois par semaine'  id='choice_4_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_0' id='label_4_14_0' class='gform-field-label gform-field-label--type-inline'>Moins d&#8217;une fois par semaine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='[B] 2 \u00e0 3 fois par semaine'  id='choice_4_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_1' id='label_4_14_1' class='gform-field-label gform-field-label--type-inline'>2 \u00e0 3 fois par semaine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='[C] Tous les jours'  id='choice_4_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_2' id='label_4_14_2' class='gform-field-label gform-field-label--type-inline'>Tous les jours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='[D] Plusieurs fois par jour'  id='choice_4_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_14_3' id='label_4_14_3' class='gform-field-label gform-field-label--type-inline'>Plusieurs fois par jour<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_27' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_8' class='gform_page' data-js='page-field-id-27' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_28\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_28\" >Vos habitudes alimentaires<\/div><fieldset id=\"field_4_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_15\" ><legend class='gfield_label gform-field-label' >Quelle est votre consommation de produits sucr\u00e9s (sodas, g\u00e2teaux, glaces, biscuits, cr\u00e8mes dessert&#8230;) ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_15'>\n\t\t\t<div class='gchoice gchoice_4_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='[A] Moins d&#039;une fois par semaine'  id='choice_4_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_15_0' id='label_4_15_0' class='gform-field-label gform-field-label--type-inline'>Moins d&#8217;une fois par semaine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='[B] 2 \u00e0 3 fois par semaine'  id='choice_4_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_15_1' id='label_4_15_1' class='gform-field-label gform-field-label--type-inline'>2 \u00e0 3 fois par semaine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='[C] Tous les jours'  id='choice_4_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_15_2' id='label_4_15_2' class='gform-field-label gform-field-label--type-inline'>Tous les jours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='[D] Plusieurs fois par jour'  id='choice_4_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_15_3' id='label_4_15_3' class='gform-field-label gform-field-label--type-inline'>Plusieurs fois par jour<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_29' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_9' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_30\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_30\" >Votre rythme de vie<\/div><fieldset id=\"field_4_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full last_is_none gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_31\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Avez-vous par jour au moins 30 minutes d&#039;activit\u00e9 ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_31'><div class='gchoice gchoice_4_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='[A] Domestique (m\u00e9nage, repassage, entretien de la maison,\u2026)'  id='choice_4_31_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_1' id='label_4_31_1' class='gform-field-label gform-field-label--type-inline'>Domestique (m\u00e9nage, repassage, entretien de la maison,\u2026)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='[B] Travail (manutention, transport, marche,...)'  id='choice_4_31_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_2' id='label_4_31_2' class='gform-field-label gform-field-label--type-inline'>Travail (manutention, transport, marche,&#8230;)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='[C] De loisir (jardinage, bricolage, randonn\u00e9es, marche rapide, v\u00e9lo\u2026)'  id='choice_4_31_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_3' id='label_4_31_3' class='gform-field-label gform-field-label--type-inline'>De loisir (jardinage, bricolage, randonn\u00e9es, marche rapide, v\u00e9lo\u2026)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='[D] Aucune'  id='choice_4_31_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_4' id='label_4_31_4' class='gform-field-label gform-field-label--type-inline'>Aucune<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_33' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_10' class='gform_page' data-js='page-field-id-33' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_34\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_34\" >Votre rythme de vie<\/div><fieldset id=\"field_4_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_32\" ><legend class='gfield_label gform-field-label' >Combien d&#039;heures de sport faites-vous par semaine ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_32'>\n\t\t\t<div class='gchoice gchoice_4_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='[A] Moins d&#039;1h'  id='choice_4_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_32_0' id='label_4_32_0' class='gform-field-label gform-field-label--type-inline'>Moins d&#8217;1h<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='[B] De 1 \u00e0 2h'  id='choice_4_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_32_1' id='label_4_32_1' class='gform-field-label gform-field-label--type-inline'>De 1 \u00e0 2h<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='[C] De 3 \u00e0 5h'  id='choice_4_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_32_2' id='label_4_32_2' class='gform-field-label gform-field-label--type-inline'>De 3 \u00e0 5h<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='[D] De 5 \u00e0 10h'  id='choice_4_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_32_3' id='label_4_32_3' class='gform-field-label gform-field-label--type-inline'>De 5 \u00e0 10h<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='[E] &gt; 10h'  id='choice_4_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_32_4' id='label_4_32_4' class='gform-field-label gform-field-label--type-inline'>> 10h<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_35' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_11' class='gform_page' data-js='page-field-id-35' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_36\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_36\" >Vous et votre poids<\/div><fieldset id=\"field_4_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_37\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous perdre du poids ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_37'>\n\t\t\t<div class='gchoice gchoice_4_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='[A] Non, je suis bien comme je suis !'  id='choice_4_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_37_0' id='label_4_37_0' class='gform-field-label gform-field-label--type-inline'>Non, je suis bien comme je suis !<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='[B] Oui, j\u2019aimerais une silhouette plus fine'  id='choice_4_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_37_1' id='label_4_37_1' class='gform-field-label gform-field-label--type-inline'>Oui, j\u2019aimerais une silhouette plus fine<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_38\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_38\" ><label class='gfield_label gform-field-label' for='input_4_38'>Quel poids souhaitez-vous obtenir ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_38' id='input_4_38' type='number' step='any'   value='' class='large'    placeholder='en kg (ex:65)' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_4_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full only_2_choices gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_39\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Quelles sont les causes de votre prise de poids ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_39'><div class='gchoice gchoice_4_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='[A] Mauvaises habitudes'  id='choice_4_39_1'   aria-describedby=\"gfield_description_4_39\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_1' id='label_4_39_1' class='gform-field-label gform-field-label--type-inline'>Mauvaises habitudes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='[B] Grossesse'  id='choice_4_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_2' id='label_4_39_2' class='gform-field-label gform-field-label--type-inline'>Grossesse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='[C] M\u00e9nopause'  id='choice_4_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_3' id='label_4_39_3' class='gform-field-label gform-field-label--type-inline'>M\u00e9nopause<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.4' type='checkbox'  value='[D] Manque d&#039;activit\u00e9'  id='choice_4_39_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_4' id='label_4_39_4' class='gform-field-label gform-field-label--type-inline'>Manque d&#8217;activit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.5' type='checkbox'  value='[E] Stress, fatigue'  id='choice_4_39_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_5' id='label_4_39_5' class='gform-field-label gform-field-label--type-inline'>Stress, fatigue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.6' type='checkbox'  value='[F] Maladie \/ m\u00e9dicaments'  id='choice_4_39_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_6' id='label_4_39_6' class='gform-field-label gform-field-label--type-inline'>Maladie \/ m\u00e9dicaments<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.7' type='checkbox'  value='[G] Arr\u00eat du tabac'  id='choice_4_39_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_7' id='label_4_39_7' class='gform-field-label gform-field-label--type-inline'>Arr\u00eat du tabac<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.8' type='checkbox'  value='[H] Emploi du temps surcharg\u00e9'  id='choice_4_39_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_8' id='label_4_39_8' class='gform-field-label gform-field-label--type-inline'>Emploi du temps surcharg\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.9' type='checkbox'  value='[I] Manque de motivation'  id='choice_4_39_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_9' id='label_4_39_9' class='gform-field-label gform-field-label--type-inline'>Manque de motivation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.11' type='checkbox'  value='[J] Reprise de poids'  id='choice_4_39_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_11' id='label_4_39_11' class='gform-field-label gform-field-label--type-inline'>Reprise de poids<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_39_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.12' type='checkbox'  value='[K] Rien de tout cela'  id='choice_4_39_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_39_12' id='label_4_39_12' class='gform-field-label gform-field-label--type-inline'>Rien de tout cela<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_39'>(2 choix maximum)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_42' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_12' class='gform_page' data-js='page-field-id-42' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_43\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_43\" >Vous et le sport<\/div><fieldset id=\"field_4_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_44\" ><legend class='gfield_label gform-field-label' >Quelle est votre pratique sportive ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_44'>\n\t\t\t<div class='gchoice gchoice_4_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='[A] Je pr\u00e9f\u00e8re rester dans mon canap\u00e9'  id='choice_4_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_44_0' id='label_4_44_0' class='gform-field-label gform-field-label--type-inline'>Je pr\u00e9f\u00e8re rester dans mon canap\u00e9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='[B] Je souhaite reprendre le sport'  id='choice_4_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_44_1' id='label_4_44_1' class='gform-field-label gform-field-label--type-inline'>Je souhaite reprendre le sport<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_44_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='[C] Je suis sportif occasionnel'  id='choice_4_44_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_44_2' id='label_4_44_2' class='gform-field-label gform-field-label--type-inline'>Je suis sportif occasionnel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_44_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='[D] Je fais du sport r\u00e9guli\u00e8rement'  id='choice_4_44_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_44_3' id='label_4_44_3' class='gform-field-label gform-field-label--type-inline'>Je fais du sport r\u00e9guli\u00e8rement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_44_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='[E] Je suis sportif de haut niveau'  id='choice_4_44_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_44_4' id='label_4_44_4' class='gform-field-label gform-field-label--type-inline'>Je suis sportif de haut niveau<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_45\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full only_2_choices gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_45\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Quelles sont vos motivations ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_45'><div class='gchoice gchoice_4_45_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='[A] Prise de masse musculaire'  id='choice_4_45_1'   aria-describedby=\"gfield_description_4_45\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_45_1' id='label_4_45_1' class='gform-field-label gform-field-label--type-inline'>Prise de masse musculaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_45_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='[B] Augmentation des performances'  id='choice_4_45_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_45_2' id='label_4_45_2' class='gform-field-label gform-field-label--type-inline'>Augmentation des performances<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_45_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='[C] R\u00e9cup\u00e9ration'  id='choice_4_45_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_45_3' id='label_4_45_3' class='gform-field-label gform-field-label--type-inline'>R\u00e9cup\u00e9ration<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_45'>(2 choix maximum)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_48' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_13' class='gform_page' data-js='page-field-id-48' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_49\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_49\" >Votre bien-\u00eatre<\/div><fieldset id=\"field_4_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full only_3_choices gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_50\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Que souhaitez-vous am\u00e9liorer dans votre quotidien ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_50'><div class='gchoice gchoice_4_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='[A] Manger \u00e9quilibr\u00e9, rapidement'  id='choice_4_50_1'   aria-describedby=\"gfield_description_4_50\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_1' id='label_4_50_1' class='gform-field-label gform-field-label--type-inline'>Manger \u00e9quilibr\u00e9, rapidement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='[B] D\u00e9toxifier mon corps'  id='choice_4_50_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_2' id='label_4_50_2' class='gform-field-label gform-field-label--type-inline'>D\u00e9toxifier mon corps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='[C] Retrouver du tonus et de la vitalit\u00e9'  id='choice_4_50_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_3' id='label_4_50_3' class='gform-field-label gform-field-label--type-inline'>Retrouver du tonus et de la vitalit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='[D] Stopper les compulsions alimentaires'  id='choice_4_50_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_4' id='label_4_50_4' class='gform-field-label gform-field-label--type-inline'>Stopper les compulsions alimentaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='[E] Retrouver un confort digestif'  id='choice_4_50_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_5' id='label_4_50_5' class='gform-field-label gform-field-label--type-inline'>Retrouver un confort digestif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='[F] Arr\u00eater de fumer'  id='choice_4_50_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_6' id='label_4_50_6' class='gform-field-label gform-field-label--type-inline'>Arr\u00eater de fumer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.7' type='checkbox'  value='[G] La qualit\u00e9 de votre sommeil'  id='choice_4_50_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_7' id='label_4_50_7' class='gform-field-label gform-field-label--type-inline'>La qualit\u00e9 de votre sommeil<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.8' type='checkbox'  value='[H] Retrouver bien-\u00eatre et s\u00e9r\u00e9nit\u00e9'  id='choice_4_50_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_8' id='label_4_50_8' class='gform-field-label gform-field-label--type-inline'>Retrouver bien-\u00eatre et s\u00e9r\u00e9nit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.9' type='checkbox'  value='[I] Renforcer vos d\u00e9fenses immunitaires'  id='choice_4_50_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_9' id='label_4_50_9' class='gform-field-label gform-field-label--type-inline'>Renforcer vos d\u00e9fenses immunitaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.11' type='checkbox'  value='[J] Am\u00e9liorer ma circulation sanguine'  id='choice_4_50_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_11' id='label_4_50_11' class='gform-field-label gform-field-label--type-inline'>Am\u00e9liorer ma circulation sanguine<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_50_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.12' type='checkbox'  value='[K] Gagner en souplesse articulaire'  id='choice_4_50_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_12' id='label_4_50_12' class='gform-field-label gform-field-label--type-inline'>Gagner en souplesse articulaire<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_50'>(3 choix maximum)<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_14' class='gform_page' data-js='page-field-id-51' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_52\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_52\" >Vos informations personnelles<\/div><fieldset id=\"field_4_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full last_is_none gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_53\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Souffrez-vous des pathologies suivantes ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_53'><div class='gchoice gchoice_4_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='[A] Troubles alimentaires'  id='choice_4_53_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_1' id='label_4_53_1' class='gform-field-label gform-field-label--type-inline'>Troubles alimentaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='[B] Insuffisance r\u00e9nale'  id='choice_4_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_2' id='label_4_53_2' class='gform-field-label gform-field-label--type-inline'>Insuffisance r\u00e9nale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='[C] Maladie inflammatoire des intestins'  id='choice_4_53_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_3' id='label_4_53_3' class='gform-field-label gform-field-label--type-inline'>Maladie inflammatoire des intestins<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='[D] Diab\u00e8te'  id='choice_4_53_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_4' id='label_4_53_4' class='gform-field-label gform-field-label--type-inline'>Diab\u00e8te<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.5' type='checkbox'  value='[E] Troubles de la thyro\u00efde'  id='choice_4_53_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_5' id='label_4_53_5' class='gform-field-label gform-field-label--type-inline'>Troubles de la thyro\u00efde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.6' type='checkbox'  value='[F] Troubles cardiovasculaires'  id='choice_4_53_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_6' id='label_4_53_6' class='gform-field-label gform-field-label--type-inline'>Troubles cardiovasculaires<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.7' type='checkbox'  value='[G] Aucune de ces pathologies'  id='choice_4_53_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_7' id='label_4_53_7' class='gform-field-label gform-field-label--type-inline'>Aucune de ces pathologies<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_56' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_15' class='gform_page' data-js='page-field-id-56' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_57\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_57\" >Vos informations personnelles<\/div><fieldset id=\"field_4_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_54\" ><legend class='gfield_label gform-field-label' >Avez-vous des allergies \/ intol\u00e9rances alimentaires ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_54'>\n\t\t\t<div class='gchoice gchoice_4_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='[A] Oui'  id='choice_4_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_0' id='label_4_54_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='[B] Non'  id='choice_4_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_1' id='label_4_54_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_16' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_59\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_59\" >Vos informations personnelles<\/div><fieldset id=\"field_4_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full reply_with_smileys gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_55\" ><legend class='gfield_label gform-field-label' >Quel est votre degr\u00e9 de motivation ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_55'>\n\t\t\t<div class='gchoice gchoice_4_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Motivation 1\/5'  id='choice_4_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_0' id='label_4_55_0' class='gform-field-label gform-field-label--type-inline'>Motivation 1\/5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Motivation 2\/5'  id='choice_4_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_1' id='label_4_55_1' class='gform-field-label gform-field-label--type-inline'>Motivation 2\/5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_55_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Motivation 3\/5'  id='choice_4_55_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_2' id='label_4_55_2' class='gform-field-label gform-field-label--type-inline'>Motivation 3\/5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_55_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Motivation 4\/5'  id='choice_4_55_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_3' id='label_4_55_3' class='gform-field-label gform-field-label--type-inline'>Motivation 4\/5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_55_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Motivation 5\/5'  id='choice_4_55_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_55_4' id='label_4_55_4' class='gform-field-label gform-field-label--type-inline'>Motivation 5\/5<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <button class='button gform_next_button' id='gform_next_button_4'><span>Start mijn BodyCheck<\/span><svg width=\"22\" height=\"17\" viewBox=\"0 0 22 17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M21 7.6L13.7 0.3C13.3 -0.1 12.7 -0.1 12.3 0.3C11.9 0.7 11.9 1.3 12.3 1.7L17.9 7.3H1C0.4 7.3 0 7.7 0 8.3C0 8.9 0.4 9.3 1 9.3H17.9L12.3 14.9C11.9 15.3 11.9 15.9 12.3 16.3C12.5 16.5 12.8 16.6 13 16.6C13.2 16.6 13.5 16.5 13.7 16.3L21 9C21.4 8.6 21.4 7.9 21 7.6Z\" fill=\"white\"\/><\/svg><\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_17' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_61\" class=\"gfield gfield--type-html gfield--width-full subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_61\" >Vos coordonn\u00e9es<\/div><fieldset id=\"field_4_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full no_title field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_62\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Partager BodyCheck<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_62'><div class='gchoice gchoice_4_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='Partager votre BodyCheck avec un conseiller' checked='checked' id='choice_4_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_62_1' id='label_4_62_1' class='gform-field-label gform-field-label--type-inline'>Partager votre BodyCheck avec un conseiller<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_63\" class=\"gfield gfield--type-html gfield--width-full warning nopdf gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_63\" >Pour profiter d\u2019un accompagnement personnalis\u00e9 et sur mesure, partagez votre BodyCheck avec un conseiller !<\/div><fieldset id=\"field_4_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full nopdf gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_64\" ><legend class='gfield_label gform-field-label' >Mes r\u00e9sultats<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_64'>\n\t\t\t<div class='gchoice gchoice_4_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='[A] - J\u2019ai d\u00e9j\u00e0 un compte, je me connecte pour conserver les r\u00e9sultats de mon BodyCheck'  id='choice_4_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_64_0' id='label_4_64_0' class='gform-field-label gform-field-label--type-inline'>J\u2019ai d\u00e9j\u00e0 un compte, je me connecte pour conserver les r\u00e9sultats de mon BodyCheck<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='[B] - Je cr\u00e9e un compte pour conserver les r\u00e9sultats de mon BodyCheck'  id='choice_4_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_64_1' id='label_4_64_1' class='gform-field-label gform-field-label--type-inline'>Je cr\u00e9e un compte pour conserver les r\u00e9sultats de mon BodyCheck<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='[C] - Je ne souhaite pas cr\u00e9er de compte'  id='choice_4_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_64_2' id='label_4_64_2' class='gform-field-label gform-field-label--type-inline'>Je ne souhaite pas cr\u00e9er de compte<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_68\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_68\" ><label class='gfield_label gform-field-label' for='input_4_68'>Pour recevoir votre bodycheck, pouvez-vous pr\u00e9ciser votre mail ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_68' id='input_4_68' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_66\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_66\" ><label class='gfield_label gform-field-label' for='input_4_66'>Votre t\u00e9l\u00e9phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_4_66' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_66\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_66'>(votre conseiller pourra vous accompagner de fa\u00e7on personnalis\u00e9e pour aller plus loin)<\/div><\/div><div id=\"field_4_67\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_67\" ><label class='gfield_label gform-field-label' for='input_4_67'>Votre code postal<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_4_67' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_67\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_67'>(cette information nous permettra de vous mettre en relation avec un conseiller pr\u00e8s de chez vous)<\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_4' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' value='Pr\u00e9c\u00e9dent'  \/> <input type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' value='Envoyer'  \/> <input type='hidden' name='gform_ajax' value='form_id=4&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles={&quot;formId&quot;:&quot;4&quot;,&quot;title&quot;:false,&quot;description&quot;:false,&quot;ajax&quot;:true,&quot;formPreview&quot;:false}&amp;hash=5a98ac53cd3af17b56140dc018d38c65' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='{&quot;formId&quot;:&quot;4&quot;,&quot;title&quot;:false,&quot;description&quot;:false,&quot;ajax&quot;:true,&quot;formPreview&quot;:false}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' 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