{"id":15338,"date":"2020-05-25T22:19:25","date_gmt":"2020-05-26T08:19:25","guid":{"rendered":"https:\/\/www.service-public.pf\/dsp\/?page_id=15338"},"modified":"2020-05-25T23:45:32","modified_gmt":"2020-05-26T09:45:32","slug":"test-motivation-tabac","status":"publish","type":"page","link":"https:\/\/www.service-public.pf\/dsp\/test-motivation-tabac\/","title":{"rendered":"Teste ta motivation \u00e0 l&rsquo;arr\u00eat du tabac"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:6%;--awb-padding-right:6%;--awb-padding-bottom:6%;--awb-padding-left:6%;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-padding-top:6%;--awb-padding-right:6%;--awb-padding-bottom:6%;--awb-padding-left:6%;--awb-bg-color:#ffffff;--awb-bg-color-hover:#ffffff;--awb-bg-size:cover;--awb-margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-column-content-centered\"><div class=\"fusion-column-content\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-highlight fusion-animate-once fusion-highlight-underline fusion-title-size-one\" style=\"--awb-text-color:#ff9e00;--awb-highlight-color:#ff9e00;\" data-highlight=\"underline\"><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:34;line-height:1.4;\"><span class=\"fusion-highlighted-text-prefix\"><\/span> <span class=\"fusion-highlighted-text-wrapper\"><span class=\"fusion-highlighted-text\" style=\"color:#ff9e00;\">Teste ta motivation \u00e0 l'arr\u00eat du tabac<\/span><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 500 150\" preserveAspectRatio=\"none\"><path d=\"M8.1,146.2c0,0,240.6-55.6,479-13.8\"><\/path><\/svg><\/span> <span class=\"fusion-highlighted-text-postfix\"><\/span><\/h1><\/div><div class=\"fusion-text fusion-text-1\"><p style=\"text-align: center\"><span class=\"gform_description\">ARR\u00caTER DE FUMER\u202f? C\u2019EST UNE D\u00c9CISION IMPORTANTE. IL TE FAUT PESER LE POUR ET LE CONTRE AFIN DE RENFORCER TA MOTIVATION.<\/span><\/p>\n<\/div><div class=\"fusion-text fusion-text-2\"><p style=\"text-align: center\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_17' ><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_17' id='gform_17'  action='\/dsp\/wp-json\/wp\/v2\/pages\/15338\/#gf_17' data-formid='17' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_17_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_1\" ><label class='gfield_label gform-field-label' >Sur une \u00e9chelle de 1 \u00e0 5, \u00e0 quel niveau se situe ton intention d&#039;arr\u00eater de fumer ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_1'>\n\t\t\t<li class='gchoice gchoice_17_1_0'>\n\t\t\t\t<input name='input_1' type='radio' value='1'  id='choice_17_1_0'    \/>\n\t\t\t\t<label for='choice_17_1_0' id='label_17_1_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_1'>\n\t\t\t\t<input name='input_1' type='radio' value='2'  id='choice_17_1_1'    \/>\n\t\t\t\t<label for='choice_17_1_1' id='label_17_1_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_2'>\n\t\t\t\t<input name='input_1' type='radio' value='3'  id='choice_17_1_2'    \/>\n\t\t\t\t<label for='choice_17_1_2' id='label_17_1_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_3'>\n\t\t\t\t<input name='input_1' type='radio' value='4'  id='choice_17_1_3'    \/>\n\t\t\t\t<label for='choice_17_1_3' id='label_17_1_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_4'>\n\t\t\t\t<input name='input_1' type='radio' value='5'  id='choice_17_1_4'    \/>\n\t\t\t\t<label for='choice_17_1_4' id='label_17_1_4' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_17_1'>0 signifie que tu n\u2019as pas du tout envie d\u2019arr\u00eater de fumer. \n5 signifie que tu es bien d\u00e9cid\u00e9(e) \u00e0 arr\u00eater de fumer.<\/div><\/li><li id=\"field_17_3\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites faire des \u00e9conomies ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_3'><li class='gchoice gchoice_17_3_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.1' type='checkbox'  value='Pas du tout'  id='choice_17_3_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_3_1' id='label_17_3_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_3_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_3_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_3_2' id='label_17_3_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_3_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.3' type='checkbox'  value='Assez'  id='choice_17_3_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_3_3' id='label_17_3_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_3_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.4' type='checkbox'  value='Beaucoup'  id='choice_17_3_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_3_4' id='label_17_3_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_4\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_4\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites prot\u00e9ger la sant\u00e9 de ton entourage proche ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_4'><li class='gchoice gchoice_17_4_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.1' type='checkbox'  value='Pas du tout'  id='choice_17_4_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_4_1' id='label_17_4_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_4_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_4_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_4_2' id='label_17_4_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_4_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.3' type='checkbox'  value='Assez'  id='choice_17_4_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_4_3' id='label_17_4_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_4_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.4' type='checkbox'  value='Beaucoup'  id='choice_17_4_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_4_4' id='label_17_4_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_5\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites \u00eatre en meilleure sant\u00e9 ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_5'><li class='gchoice gchoice_17_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Pas du tout'  id='choice_17_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_5_1' id='label_17_5_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_5_2' id='label_17_5_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Assez'  id='choice_17_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_5_3' id='label_17_5_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Beaucoup'  id='choice_17_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_5_4' id='label_17_5_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_7\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites mieux respirer ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_7'><li class='gchoice gchoice_17_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Pas du tout'  id='choice_17_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_7_1' id='label_17_7_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_7_2' id='label_17_7_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Assez'  id='choice_17_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_7_3' id='label_17_7_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Beaucoup'  id='choice_17_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_7_4' id='label_17_7_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_6\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_6\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites retrouver le sens du go\u00fbt et de l&#039;odorat ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_6'><li class='gchoice gchoice_17_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Pas du tout'  id='choice_17_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_6_1' id='label_17_6_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_6_2' id='label_17_6_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_6_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.3' type='checkbox'  value='Assez'  id='choice_17_6_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_6_3' id='label_17_6_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_6_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.4' type='checkbox'  value='Beaucoup'  id='choice_17_6_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_6_4' id='label_17_6_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_9\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites am\u00e9liorer tes performances sportives ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_9'><li class='gchoice gchoice_17_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='Pas du tout'  id='choice_17_9_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_9_1' id='label_17_9_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_9_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_9_2' id='label_17_9_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.3' type='checkbox'  value='Assez'  id='choice_17_9_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_9_3' id='label_17_9_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_9_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.4' type='checkbox'  value='Beaucoup'  id='choice_17_9_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_9_4' id='label_17_9_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_10\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites retrouver un meilleur teint ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_10'><li class='gchoice gchoice_17_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Pas du tout'  id='choice_17_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_10_1' id='label_17_10_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_10_2' id='label_17_10_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Assez'  id='choice_17_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_10_3' id='label_17_10_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Beaucoup'  id='choice_17_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_10_4' id='label_17_10_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites retrouver une meilleure haleine ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_11'><li class='gchoice gchoice_17_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Pas du tout'  id='choice_17_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_11_1' id='label_17_11_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_11_2' id='label_17_11_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Assez'  id='choice_17_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_11_3' id='label_17_11_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Beaucoup'  id='choice_17_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_11_4' id='label_17_11_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_12\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites accompagner un proche ou un ami qui souhaite arr\u00eater ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_12'><li class='gchoice gchoice_17_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='Pas du tout'  id='choice_17_12_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_12_1' id='label_17_12_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_12_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_12_2' id='label_17_12_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='Assez'  id='choice_17_12_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_12_3' id='label_17_12_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_12_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.4' type='checkbox'  value='Beaucoup'  id='choice_17_12_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_12_4' id='label_17_12_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_13\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En arr\u00eatant de fumer tu souhaites lancer le mouvement pour que d\u2019autres de ton entourage prennent cette nouvelle r\u00e9solution ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_13'><li class='gchoice gchoice_17_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Pas du tout'  id='choice_17_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_13_1' id='label_17_13_1' class='gform-field-label gform-field-label--type-inline'>Pas du tout<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Peut-\u00eatre'  id='choice_17_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_13_2' id='label_17_13_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Assez'  id='choice_17_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_13_3' id='label_17_13_3' class='gform-field-label gform-field-label--type-inline'>Assez<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_17_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Beaucoup'  id='choice_17_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_13_4' id='label_17_13_4' class='gform-field-label gform-field-label--type-inline'>Beaucoup<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_20\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_20\" ><label class='gfield_label gform-field-label' for='input_17_20'>As-tu d&#039;autres motivations ?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_17_20' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_17' class='gform_button button' value='J&#039;ai fais le point !'  onclick='if(window[\"gf_submitting_17\"]){return false;}  if( !jQuery(\"#gform_17\")[0].checkValidity || 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