{"id":5131,"date":"2024-03-29T14:01:52","date_gmt":"2024-03-29T13:01:52","guid":{"rendered":"https:\/\/www.wheeleo.eu\/test-agreement\/"},"modified":"2025-08-29T15:56:56","modified_gmt":"2025-08-29T13:56:56","slug":"test","status":"publish","type":"page","link":"https:\/\/www.wheeleo.eu\/en\/test\/","title":{"rendered":"Test agreement"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5131\" class=\"elementor elementor-5131 elementor-3876\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5298bc49 e-con-full e-flex e-con e-parent\" data-id=\"5298bc49\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t<div class=\"elementor-element elementor-element-50d3dd0 e-con-full e-flex e-con e-child\" data-id=\"50d3dd0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3c6dec80 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"3c6dec80\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">To test is to adopt<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7783b258 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"7783b258\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Test agreement<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c29ceab elementor-widget elementor-widget-text-editor\" data-id=\"1c29ceab\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>You have expressed an interest in the Wheeleo\u00ae and would like to obtain a copy to observe its effect in your department\/institution\/cabinet. InnoRehab offers to send you a free Wheeleo\u00ae walking aid companion so that you can test it for a period of 2 weeks.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d3ac2c5 elementor-align-justify elementor-widget__width-inherit elementor-widget elementor-widget-button\" data-id=\"d3ac2c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#obtenirUnTest\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Get a test<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-131c8ccf e-con-full e-flex e-con e-child\" data-id=\"131c8ccf\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;background_motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateX_effect&quot;:&quot;yes&quot;,&quot;background_motion_fx_translateX_direction&quot;:&quot;negative&quot;,&quot;background_motion_fx_translateX_speed&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_list&quot;:[],&quot;background_motion_fx_translateX_affectedRange&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:{&quot;start&quot;:0,&quot;end&quot;:100}},&quot;background_motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\">\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-34cc323 e-flex e-con-boxed e-con e-parent\" data-id=\"34cc323\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-710165b e-con-full e-flex e-con e-child\" data-id=\"710165b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e5de528 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"e5de528\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2><strong>Proposal:<\/strong><\/h2><div><p>We are willing to allow you to test the Wheeleo\u00ae with your patients. We will send you a demonstration Wheeleo\u00ae by courier.  Shipping costs (outward and return) are at our expense (for Belgium, France, Luxembourg, the Netherlands, Germany). We leave the Wheeleo\u00ae for testing during a <strong>2-week test period<\/strong>. At the end of the test period, we take stock together. Either purchase or return.<\/p><\/div><p><strong><span class=\"size\">Does your establishment need to go through a tender process or a framework contract for equipment purchases? The test model cannot be purchased directly? In that case, contact your supplier to organize the test.   <\/span><\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-515ef59 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"515ef59\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2><strong>Test condition:<\/strong><\/h2><div><p><strong>To be a healthcare professional<\/strong> working as a physiotherapist, occupational therapist or doctor in a hospital, rehabilitation center, nursing home, etc. This test does not apply to retailers, stores or private individuals. Wheeleo\u00ae reserves the right to accept or refuse a test request with regard to this condition. Several people must test the Wheeleo\u00ae to benefit from this provision.  <\/p><p>A test for an individual or a patient? Visit our <a href=\"https:\/\/www.wheeleo.eu\/en\/test-the-wheeleo\/\">&#8220;test the Wheeleo\u00ae&#8221;<\/a> page!<\/p><\/div><div>Prior to the test period, we ask the team in charge of the test to follow a presentation (30-45 minutes maximum) on &#8220;Wheeleo\u00ae: what is it?&#8221; given by Geoffroy, physiotherapist and Wheeleo\u00ae designer.<\/div><div> <\/div><div>For the online presentation: <a href=\"https:\/\/wheeleo.zohobookings.eu\/#\/customer\/presentation\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/wheeleo.zohobookings.eu\/#\/customer\/presentation<\/a><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f68ecaa e-con-full e-flex e-con e-child\" data-id=\"f68ecaa\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-83716d6 elementor-align-justify elementor-widget__width-inherit elementor-widget elementor-widget-button\" data-id=\"83716d6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/wheeleo.zohobookings.eu\/#\/customer\/presentation\" target=\"_blank\" rel=\"noopener\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Schedule an online presentation<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-09b78ec e-con-full e-flex e-con e-child\" data-id=\"09b78ec\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-17a7290 elementor-widget elementor-widget-text-editor\" data-id=\"17a7290\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div><h2><strong>At the end of the test :<\/strong><\/h2><p>You have two choices:<\/p><p>&#8211; Or you&#8217;re convinced by Wheeleo\u00ae.  <span class=\"size\">You can then keep the test Wheeleo\u00ae. Wheeleo\u00ae will then send you the invoice. The price is \u20ac299 incl. VAT. Free shipping. An official price quote can be sent to you in order to obtain the budgets. <\/span><\/p><\/div><div> <\/div><div>&#8211; Or you do not wish to invest in this rehabilitation equipment at this time: we will send you a return label. You agree to return the Wheeleo\u00ae in its original box by dropping it off at a <a href=\"https:\/\/relais.dpd.fr\/fr\/recherche-relais\" target=\"_blank\" rel=\"noopener\">DPD relay point<\/a>.<\/div><div> <\/div><div>At the end of the test, we ask the healthcare professionals who tested the Wheeleo\u00ae to complete <a href=\"https:\/\/www.wheeleo.eu\/en\/test-evaluation\/\" target=\"_blank\" rel=\"noopener\">a satisfaction survey<\/a>.<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-caa34c9 elementor-widget elementor-widget-text-editor\" data-id=\"caa34c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2><strong>Consideration :<\/strong><\/h2><p><strong>You agree to :<\/strong><\/p><p>&#8211; Have a quick weekly contact with the Wheeleo\u00ae team during the test period.<br>&#8211; Provide detailed feedback (from patients and therapists) to enable us to further develop Wheeleo\u00ae. To help you objectify the effects, we invite you to print out and fill in the test observation form, available <a href=\"https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Feedback_test_V0.5-EN.pdf\">here<\/a>.<\/p><p>We&#8217;re sure you&#8217;ll discover the unique benefits of Wheeleo\u00ae for your patients&#8217; revalidation and comfort.  <br>We look forward to hearing your feedback on this innovative mobility aid.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8de4c90 e-flex e-con-boxed e-con e-parent\" data-id=\"8de4c90\" data-element_type=\"container\" data-e-type=\"container\" id=\"obtenirUnTest\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-7bcdd8d e-con-full e-flex e-con e-child\" data-id=\"7bcdd8d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fd72a36 elementor-widget elementor-widget-image\" data-id=\"fd72a36\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;sticky&quot;:&quot;top&quot;,&quot;sticky_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;],&quot;sticky_offset&quot;:140,&quot;sticky_parent&quot;:&quot;yes&quot;,&quot;sticky_effects_offset&quot;:0,&quot;sticky_anchor_link_offset&quot;:0}\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" loading=\"lazy\" width=\"768\" height=\"432\" src=\"https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-768x432.jpg\" class=\"attachment-medium_large size-medium_large wp-image-4619\" alt=\"\" srcset=\"https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-768x432.jpg 768w, https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-300x169.jpg 300w, https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-1024x576.jpg 1024w, https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-1536x864.jpg 1536w, https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11-600x338.jpg 600w, https:\/\/www.wheeleo.eu\/wp-content\/uploads\/2024\/04\/Wheeleo-kit-com11.jpg 1920w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2b8f1ae e-con-full e-flex e-con e-child\" data-id=\"2b8f1ae\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bcc2624 elementor-widget elementor-widget-wpforms\" data-id=\"bcc2624\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-14032\"><form id=\"wpforms-form-14032\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"14032\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/5131\" data-token=\"b1cd15716b9fe49407fcbe74ce2779e6\" data-token-time=\"1776315723\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-14032-field_22-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"22\"><input type=\"hidden\" id=\"wpforms-14032-field_22\" name=\"wpforms[fields][22]\" value=\"EN\"><\/div><div id=\"wpforms-14032-field_23-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"23\"><input type=\"hidden\" id=\"wpforms-14032-field_23\" name=\"wpforms[fields][23]\" value=\"test agreement\"><\/div><div id=\"wpforms-14032-field_26-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"26\"><input type=\"hidden\" id=\"wpforms-14032-field_26\" name=\"wpforms[fields][26]\" value=\"N Pro\"><\/div><div id=\"wpforms-14032-field_21-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Contact information <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-14032-field_21\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][21][first]\" aria-errormessage=\"wpforms-14032-field_21-error\" required><label for=\"wpforms-14032-field_21\" class=\"wpforms-field-sublabel after\">First Name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-14032-field_21-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][21][last]\" aria-errormessage=\"wpforms-14032-field_21-last-error\" required><label for=\"wpforms-14032-field_21-last\" class=\"wpforms-field-sublabel after\">Last Name<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-14032-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_5\">Professional email addresses <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-14032-field_5\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" aria-errormessage=\"wpforms-14032-field_5-error\" required><\/div><div id=\"wpforms-14032-field_6-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_6\">Business telephone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-14032-field_6\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][6]\" placeholder=\"479 09 08 03\" aria-label=\"Business telephone\" aria-errormessage=\"wpforms-14032-field_6-error\" required><\/div><div id=\"wpforms-14032-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_8\">Name of your establishment \/ institution \/ practice \/ hospital \/ center \/ ... <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-14032-field_8\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-14032-field_8-error\" required><\/div>\t\t<div id=\"wpforms-14032-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-14032-field_1\" >(billing) Message With<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-14032-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-14032-field_27-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Type of establishment <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-14032-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_1\" name=\"wpforms[fields][27]\" value=\"Hospital\" aria-errormessage=\"wpforms-14032-field_27_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_1\">Hospital<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_2\" name=\"wpforms[fields][27]\" value=\"Rehabilitation Center (SSR, CMPR, CRF, CSSR, ...)\" aria-errormessage=\"wpforms-14032-field_27_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_2\">Rehabilitation Center (SSR, CMPR, CRF, CSSR, ...)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_3\" name=\"wpforms[fields][27]\" value=\"Medical-Social Center (SESSAD, IME, ...)\" aria-errormessage=\"wpforms-14032-field_27_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_3\">Medical-Social Center (SESSAD, IME, ...)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_4\" name=\"wpforms[fields][27]\" value=\"Nursing Home \/ Residential Care Facility \/ Specialized Care Home\" aria-errormessage=\"wpforms-14032-field_27_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_4\">Nursing Home \/ Residential Care Facility \/ Specialized Care Home<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_5\" name=\"wpforms[fields][27]\" value=\"Home Care Services (SPASAD, ...)\" aria-errormessage=\"wpforms-14032-field_27_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_5\">Home Care Services (SPASAD, ...)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_6\" name=\"wpforms[fields][27]\" value=\"Health insurance\" aria-errormessage=\"wpforms-14032-field_27_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_6\">Health insurance<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_10\" name=\"wpforms[fields][27]\" value=\"Administration\" aria-errormessage=\"wpforms-14032-field_27_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_10\">Administration<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_9\" name=\"wpforms[fields][27]\" value=\"Association \/ Federation\" aria-errormessage=\"wpforms-14032-field_27_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_9\">Association \/ Federation<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_8\" name=\"wpforms[fields][27]\" value=\"School \/ University\" aria-errormessage=\"wpforms-14032-field_27_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_8\">School \/ University<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_7\" name=\"wpforms[fields][27]\" value=\"Private practice\" aria-errormessage=\"wpforms-14032-field_27_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_7\">Private practice<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_11\" name=\"wpforms[fields][27]\" value=\"Medical Center\" aria-errormessage=\"wpforms-14032-field_27_11-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_11\">Medical Center<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_27_12\" name=\"wpforms[fields][27]\" value=\"Other\" aria-errormessage=\"wpforms-14032-field_27_12-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_27_12\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-14032-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_28\">Specify &quot;other&quot;<\/label><input type=\"text\" id=\"wpforms-14032-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-14032-field_28-error\" ><\/div><div id=\"wpforms-14032-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_29\">Function in the company <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-14032-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-14032-field_29-error\" required><\/div><div id=\"wpforms-14032-field_33-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"33\"><h3 id=\"wpforms-14032-field_33\" aria-errormessage=\"wpforms-14032-field_33-error\">Delivery address<\/h3><\/div><div id=\"wpforms-14032-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_34\">Street (delivery) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-14032-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-14032-field_34-error\" required><\/div><div id=\"wpforms-14032-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_35\">Code (delivery) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-14032-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-14032-field_35-error\" required><\/div><div id=\"wpforms-14032-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_36\">City (delivery) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-14032-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-14032-field_36-error\" required><\/div><div id=\"wpforms-14032-field_24-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_24\">Country (delivery) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-14032-field_24\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][24]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select an option ---<\/option><option value=\"Belg\u00efe\"  class=\"choice-4 depth-1\"  >Belgium<\/option><option value=\"Belgique\"  class=\"choice-5 depth-1\"  >Belgium<\/option><option value=\"Belgium\"  class=\"choice-6 depth-1\"  >Belgium<\/option><option value=\"France\"  class=\"choice-7 depth-1\"  >France<\/option><option value=\"Afghanistan\"  class=\"choice-8 depth-1\"  >Afghanistan<\/option><option value=\"\u00c5land Islands\"  class=\"choice-9 depth-1\"  >\u00c5land Islands<\/option><option value=\"Albania\"  class=\"choice-10 depth-1\"  >Albania<\/option><option value=\"Algeria\"  class=\"choice-11 depth-1\"  >Algeria<\/option><option value=\"American Samoa\"  class=\"choice-12 depth-1\"  >American Samoa<\/option><option value=\"Andorra\"  class=\"choice-13 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-14 depth-1\"  >Angola<\/option><option value=\"Anguilla\"  class=\"choice-15 depth-1\"  >Anguilla<\/option><option value=\"Antarctica\"  class=\"choice-16 depth-1\"  >Antarctica<\/option><option value=\"Antigua and Barbuda\"  class=\"choice-17 depth-1\"  >Antigua and Barbuda<\/option><option value=\"Argentina\"  class=\"choice-18 depth-1\"  >Argentina<\/option><option value=\"Armenia\"  class=\"choice-19 depth-1\"  >Armenia<\/option><option value=\"Aruba\"  class=\"choice-20 depth-1\"  >Aruba<\/option><option value=\"Australia\"  class=\"choice-21 depth-1\"  >Australia<\/option><option value=\"Austria\"  class=\"choice-22 depth-1\"  >Austria<\/option><option value=\"Azerbaijan\"  class=\"choice-23 depth-1\"  >Azerbaijan<\/option><option value=\"Bahamas\"  class=\"choice-24 depth-1\"  >Bahamas<\/option><option value=\"Bahrain\"  class=\"choice-25 depth-1\"  >Bahrain<\/option><option value=\"Bangladesh\"  class=\"choice-26 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-27 depth-1\"  >Barbados<\/option><option value=\"Belarus\"  class=\"choice-28 depth-1\"  >Belarus<\/option><option value=\"Belize\"  class=\"choice-29 depth-1\"  >Belize<\/option><option value=\"Benin\"  class=\"choice-30 depth-1\"  >Benin<\/option><option value=\"Bermuda\"  class=\"choice-31 depth-1\"  >Bermuda<\/option><option value=\"Bhutan\"  class=\"choice-32 depth-1\"  >Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\"  class=\"choice-33 depth-1\"  >Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Sint Eustatius and Saba\"  class=\"choice-34 depth-1\"  >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\"  class=\"choice-35 depth-1\"  >Bosnia-Herzegovina<\/option><option value=\"Botswana\"  class=\"choice-36 depth-1\"  >Botswana<\/option><option value=\"Bouvet Island\"  class=\"choice-37 depth-1\"  >Bouvet Island<\/option><option value=\"Brazil\"  class=\"choice-38 depth-1\"  >Brazil<\/option><option value=\"Brunei Darussalam\"  class=\"choice-39 depth-1\"  >Brunei Darussalam<\/option><option value=\"Bulgaria\"  class=\"choice-40 depth-1\"  >Bulgaria<\/option><option value=\"Burkina Faso\"  class=\"choice-41 depth-1\"  >Burkina Faso<\/option><option value=\"Burundi\"  class=\"choice-42 depth-1\"  >Burundi<\/option><option value=\"Cabo Verde\"  class=\"choice-43 depth-1\"  >Cape Verde<\/option><option value=\"Cambodia\"  class=\"choice-44 depth-1\"  >Cambodia<\/option><option value=\"Cameroon\"  class=\"choice-45 depth-1\"  >Cameroon<\/option><option value=\"Canada\"  class=\"choice-46 depth-1\"  >Canada<\/option><option value=\"Cayman Islands\"  class=\"choice-47 depth-1\"  >Cayman Islands<\/option><option value=\"Central African Republic\"  class=\"choice-48 depth-1\"  >Central African Republic<\/option><option value=\"Chad\"  class=\"choice-49 depth-1\"  >Chad<\/option><option value=\"Chile\"  class=\"choice-50 depth-1\"  >Chile<\/option><option value=\"China\"  class=\"choice-51 depth-1\"  >China<\/option><option value=\"Christmas Island\"  class=\"choice-52 depth-1\"  >Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\"  class=\"choice-53 depth-1\"  >Cocos Islands (Keeling)<\/option><option value=\"Colombia\"  class=\"choice-54 depth-1\"  >Colombia<\/option><option value=\"Comoros\"  class=\"choice-55 depth-1\"  >Comoros<\/option><option value=\"Congo\"  class=\"choice-56 depth-1\"  >Congo<\/option><option value=\"Congo, Democratic Republic of the\"  class=\"choice-57 depth-1\"  >Democratic Republic of the Congo<\/option><option value=\"Cook Islands\"  class=\"choice-58 depth-1\"  >Cook Islands<\/option><option value=\"Costa Rica\"  class=\"choice-59 depth-1\"  >Costa Rica<\/option><option value=\"Croatia\"  class=\"choice-60 depth-1\"  >Croatia<\/option><option value=\"Cuba\"  class=\"choice-61 depth-1\"  >Cuba<\/option><option value=\"Cura\u00e7ao\"  class=\"choice-62 depth-1\"  >Cura\u00e7ao<\/option><option value=\"Cyprus\"  class=\"choice-63 depth-1\"  >Cyprus<\/option><option value=\"Czech Republic\"  class=\"choice-64 depth-1\"  >Czech Republic<\/option><option value=\"C\u00f4te d\u2019Ivoire\"  class=\"choice-65 depth-1\"  >C\u00f4te d'Ivoire<\/option><option value=\"Denmark\"  class=\"choice-66 depth-1\"  >Denmark<\/option><option value=\"Djibouti\"  class=\"choice-67 depth-1\"  >Djibouti<\/option><option value=\"Dominica\"  class=\"choice-68 depth-1\"  >Dominique<\/option><option value=\"Dominican Republic\"  class=\"choice-69 depth-1\"  >Dominican Republic<\/option><option value=\"Ecuador\"  class=\"choice-70 depth-1\"  >Ecuador<\/option><option value=\"Egypt\"  class=\"choice-71 depth-1\"  >Egypt<\/option><option value=\"El Salvador\"  class=\"choice-72 depth-1\"  >El Salvador<\/option><option value=\"Equatorial Guinea\"  class=\"choice-73 depth-1\"  >Equatorial Guinea<\/option><option value=\"Eritrea\"  class=\"choice-74 depth-1\"  >Eritrea<\/option><option value=\"Estonia\"  class=\"choice-75 depth-1\"  >Estonia<\/option><option value=\"Eswatini\"  class=\"choice-76 depth-1\"  >Eswatini<\/option><option value=\"Ethiopia\"  class=\"choice-77 depth-1\"  >Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\"  class=\"choice-78 depth-1\"  >Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\"  class=\"choice-79 depth-1\"  >Faroe Islands<\/option><option value=\"Fiji\"  class=\"choice-80 depth-1\"  >Fiji<\/option><option value=\"Finland\"  class=\"choice-81 depth-1\"  >Finland<\/option><option value=\"French Guiana\"  class=\"choice-82 depth-1\"  >French Guiana<\/option><option value=\"French Polynesia\"  class=\"choice-83 depth-1\"  >French Polynesia<\/option><option value=\"French Southern Territories\"  class=\"choice-84 depth-1\"  >French Southern Territories<\/option><option value=\"Gabon\"  class=\"choice-85 depth-1\"  >Gabon<\/option><option value=\"Gambia\"  class=\"choice-86 depth-1\"  >Gambia<\/option><option value=\"Georgia\"  class=\"choice-87 depth-1\"  >Georgia<\/option><option value=\"Germany\"  class=\"choice-88 depth-1\"  >Germany<\/option><option value=\"Ghana\"  class=\"choice-89 depth-1\"  >Ghana<\/option><option value=\"Gibraltar\"  class=\"choice-90 depth-1\"  >Gibraltar<\/option><option value=\"Greece\"  class=\"choice-91 depth-1\"  >Greece<\/option><option value=\"Greenland\"  class=\"choice-92 depth-1\"  >Greenland<\/option><option value=\"Grenada\"  class=\"choice-93 depth-1\"  >Granada<\/option><option value=\"Guadeloupe\"  class=\"choice-94 depth-1\"  >Guadeloupe<\/option><option value=\"Guam\"  class=\"choice-95 depth-1\"  >Guam<\/option><option value=\"Guatemala\"  class=\"choice-96 depth-1\"  >Guatemala<\/option><option value=\"Guernsey\"  class=\"choice-97 depth-1\"  >Guernsey<\/option><option value=\"Guinea\"  class=\"choice-98 depth-1\"  >Guinea<\/option><option value=\"Guinea-Bissau\"  class=\"choice-99 depth-1\"  >Guinea-Bissau<\/option><option value=\"Guyana\"  class=\"choice-100 depth-1\"  >Guyana<\/option><option value=\"Haiti\"  class=\"choice-101 depth-1\"  >Haiti<\/option><option value=\"Heard Island and McDonald Islands\"  class=\"choice-102 depth-1\"  >Heard Island and McDonald Islands<\/option><option value=\"Holy See\"  class=\"choice-103 depth-1\"  >Holy See<\/option><option value=\"Honduras\"  class=\"choice-104 depth-1\"  >Honduras<\/option><option value=\"Hong Kong\"  class=\"choice-105 depth-1\"  >Hong Kong<\/option><option value=\"Hungary\"  class=\"choice-106 depth-1\"  >Hungary<\/option><option value=\"Iceland\"  class=\"choice-107 depth-1\"  >Iceland<\/option><option value=\"India\"  class=\"choice-108 depth-1\"  >India<\/option><option value=\"Indonesia\"  class=\"choice-109 depth-1\"  >Indonesia<\/option><option value=\"Iran (Islamic Republic of)\"  class=\"choice-110 depth-1\"  >Iran (Islamic Republic of)<\/option><option value=\"Iraq\"  class=\"choice-111 depth-1\"  >Iraq<\/option><option value=\"Ireland\"  class=\"choice-112 depth-1\"  >Ireland<\/option><option value=\"Isle of Man\"  class=\"choice-113 depth-1\"  >Isle of Man<\/option><option value=\"Israel\"  class=\"choice-114 depth-1\"  >Israel<\/option><option value=\"Italy\"  class=\"choice-115 depth-1\"  >Italy<\/option><option value=\"Jamaica\"  class=\"choice-116 depth-1\"  >Jamaica<\/option><option value=\"Japan\"  class=\"choice-117 depth-1\"  >Japan<\/option><option value=\"Jersey\"  class=\"choice-118 depth-1\"  >Jersey<\/option><option value=\"Jordan\"  class=\"choice-119 depth-1\"  >Jordan<\/option><option value=\"Kazakhstan\"  class=\"choice-120 depth-1\"  >Kazakhstan<\/option><option value=\"Kenya\"  class=\"choice-121 depth-1\"  >Kenya<\/option><option value=\"Kiribati\"  class=\"choice-122 depth-1\"  >Kiribati<\/option><option value=\"Korea (Democratic People\u2019s Republic of)\"  class=\"choice-123 depth-1\"  >Korea (Democratic People's Republic of)<\/option><option value=\"Korea (Republic of)\"  class=\"choice-124 depth-1\"  >Korea (Republic of)<\/option><option value=\"Kuwait\"  class=\"choice-125 depth-1\"  >Kuwait<\/option><option value=\"Kyrgyzstan\"  class=\"choice-126 depth-1\"  >Kyrgyzstan<\/option><option value=\"Lao People\u2019s Democratic Republic\"  class=\"choice-127 depth-1\"  >Lao People's Democratic Republic<\/option><option value=\"Latvia\"  class=\"choice-128 depth-1\"  >Latvia<\/option><option value=\"Lebanon\"  class=\"choice-129 depth-1\"  >Lebanon<\/option><option value=\"Lesotho\"  class=\"choice-130 depth-1\"  >Lesotho<\/option><option value=\"Liberia\"  class=\"choice-131 depth-1\"  >Liberia<\/option><option value=\"Libya\"  class=\"choice-132 depth-1\"  >Libya<\/option><option value=\"Liechtenstein\"  class=\"choice-133 depth-1\"  >Liechtenstein<\/option><option value=\"Lithuania\"  class=\"choice-134 depth-1\"  >Lithuania<\/option><option value=\"Luxembourg\"  class=\"choice-135 depth-1\"  >Luxembourg<\/option><option value=\"Macao\"  class=\"choice-136 depth-1\"  >Macau<\/option><option value=\"Madagascar\"  class=\"choice-137 depth-1\"  >Madagascar<\/option><option value=\"Malawi\"  class=\"choice-138 depth-1\"  >Malawi<\/option><option value=\"Malaysia\"  class=\"choice-139 depth-1\"  >Malaysia<\/option><option value=\"Maldives\"  class=\"choice-140 depth-1\"  >Maldives<\/option><option value=\"Mali\"  class=\"choice-141 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-142 depth-1\"  >Malta<\/option><option value=\"Marshall Islands\"  class=\"choice-143 depth-1\"  >Marshall Islands<\/option><option value=\"Martinique\"  class=\"choice-144 depth-1\"  >Martinique<\/option><option value=\"Mauritania\"  class=\"choice-145 depth-1\"  >Mauritania<\/option><option value=\"Mauritius\"  class=\"choice-146 depth-1\"  >Mauritius<\/option><option value=\"Mayotte\"  class=\"choice-147 depth-1\"  >Mayotte<\/option><option value=\"Mexico\"  class=\"choice-148 depth-1\"  >Mexico<\/option><option value=\"Micronesia (Federated States of)\"  class=\"choice-149 depth-1\"  >Micronesia (Federated States of)<\/option><option value=\"Moldova (Republic of)\"  class=\"choice-150 depth-1\"  >Moldova (Republic of)<\/option><option value=\"Monaco\"  class=\"choice-151 depth-1\"  >Monaco<\/option><option value=\"Mongolia\"  class=\"choice-152 depth-1\"  >Mongolia<\/option><option value=\"Montenegro\"  class=\"choice-153 depth-1\"  >Montenegro<\/option><option value=\"Montserrat\"  class=\"choice-154 depth-1\"  >Montserrat<\/option><option value=\"Morocco\"  class=\"choice-155 depth-1\"  >Morocco<\/option><option value=\"Mozambique\"  class=\"choice-156 depth-1\"  >Mozambique<\/option><option value=\"Myanmar\"  class=\"choice-157 depth-1\"  >Myanmar<\/option><option value=\"Namibia\"  class=\"choice-158 depth-1\"  >Namibia<\/option><option value=\"Nauru\"  class=\"choice-159 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-160 depth-1\"  >Nepal<\/option><option value=\"Netherlands\"  class=\"choice-161 depth-1\"  >Netherlands<\/option><option value=\"New Caledonia\"  class=\"choice-162 depth-1\"  >New Caledonia<\/option><option value=\"New Zealand\"  class=\"choice-163 depth-1\"  >New Zealand<\/option><option value=\"Nicaragua\"  class=\"choice-164 depth-1\"  >Nicaragua<\/option><option value=\"Niger\"  class=\"choice-165 depth-1\"  >Niger<\/option><option value=\"Nigeria\"  class=\"choice-166 depth-1\"  >Nigeria<\/option><option value=\"Niue\"  class=\"choice-167 depth-1\"  >Niue<\/option><option value=\"Norfolk Island\"  class=\"choice-168 depth-1\"  >Norfolk Island<\/option><option value=\"North Macedonia (former Yugoslav Republic of)\"  class=\"choice-169 depth-1\"  >North Macedonia (former Yugoslav Republic of)<\/option><option value=\"Northern Mariana Islands\"  class=\"choice-170 depth-1\"  >Northern Mariana Islands<\/option><option value=\"Norway\"  class=\"choice-171 depth-1\"  >Norway<\/option><option value=\"Oman\"  class=\"choice-172 depth-1\"  >Oman<\/option><option value=\"Pakistan\"  class=\"choice-173 depth-1\"  >Pakistan<\/option><option value=\"Palau\"  class=\"choice-174 depth-1\"  >Palau<\/option><option value=\"Palestine, State of\"  class=\"choice-175 depth-1\"  >Palestine, State of<\/option><option value=\"Panama\"  class=\"choice-176 depth-1\"  >Panama<\/option><option value=\"Papua New Guinea\"  class=\"choice-177 depth-1\"  >Papua New Guinea<\/option><option value=\"Paraguay\"  class=\"choice-178 depth-1\"  >Paraguay<\/option><option value=\"Peru\"  class=\"choice-179 depth-1\"  >Peru<\/option><option value=\"Philippines\"  class=\"choice-180 depth-1\"  >Philippines<\/option><option value=\"Pitcairn\"  class=\"choice-181 depth-1\"  >Pitcairn<\/option><option value=\"Poland\"  class=\"choice-182 depth-1\"  >Poland<\/option><option value=\"Portugal\"  class=\"choice-183 depth-1\"  >Portugal<\/option><option value=\"Puerto Rico\"  class=\"choice-184 depth-1\"  >Puerto Rico<\/option><option value=\"Qatar\"  class=\"choice-185 depth-1\"  >Qatar<\/option><option value=\"R\u00e9union\"  class=\"choice-186 depth-1\"  >R\u00e9union<\/option><option value=\"Romania\"  class=\"choice-187 depth-1\"  >Romania<\/option><option value=\"Russian Federation\"  class=\"choice-188 depth-1\"  >Russian Federation<\/option><option value=\"Rwanda\"  class=\"choice-189 depth-1\"  >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\"  class=\"choice-190 depth-1\"  >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\"  class=\"choice-191 depth-1\"  >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\"  class=\"choice-192 depth-1\"  >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\"  class=\"choice-193 depth-1\"  >Saint Lucia<\/option><option value=\"Saint Martin (French part)\"  class=\"choice-194 depth-1\"  >Saint-Martin (French part)<\/option><option value=\"Saint Martin (Dutch part)\"  class=\"choice-195 depth-1\"  >Sint Maarten (Dutch part)<\/option><option value=\"Saint Pierre and Miquelon\"  class=\"choice-196 depth-1\"  >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\"  class=\"choice-197 depth-1\"  >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\"  class=\"choice-198 depth-1\"  >Samoa<\/option><option value=\"San Marino\"  class=\"choice-199 depth-1\"  >San Marino<\/option><option value=\"Sao Tome and Principe\"  class=\"choice-200 depth-1\"  >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\"  class=\"choice-201 depth-1\"  >Saudi Arabia<\/option><option value=\"Senegal\"  class=\"choice-202 depth-1\"  >Senegal<\/option><option value=\"Serbia\"  class=\"choice-203 depth-1\"  >Serbia<\/option><option value=\"Seychelles\"  class=\"choice-204 depth-1\"  >Seychelles<\/option><option value=\"Sierra Leone\"  class=\"choice-205 depth-1\"  >Sierra Leone<\/option><option value=\"Singapore\"  class=\"choice-206 depth-1\"  >Singapore<\/option><option value=\"Sint Maarten (Dutch part)\"  class=\"choice-207 depth-1\"  >Sint Martin (Dutch part)<\/option><option value=\"Slovakia\"  class=\"choice-208 depth-1\"  >Slovakia<\/option><option value=\"Slovenia\"  class=\"choice-209 depth-1\"  >Slovenia<\/option><option value=\"Solomon Islands\"  class=\"choice-210 depth-1\"  >Solomon Islands<\/option><option value=\"Somalia\"  class=\"choice-211 depth-1\"  >Somalia<\/option><option value=\"South Africa\"  class=\"choice-212 depth-1\"  >South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\"  class=\"choice-213 depth-1\"  >South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\"  class=\"choice-214 depth-1\"  >South Sudan<\/option><option value=\"Spain\"  class=\"choice-215 depth-1\"  >Spain<\/option><option value=\"Sri Lanka\"  class=\"choice-216 depth-1\"  >Sri Lanka<\/option><option value=\"Sudan\"  class=\"choice-217 depth-1\"  >Sudan<\/option><option value=\"Suriname\"  class=\"choice-218 depth-1\"  >Suriname<\/option><option value=\"Svalbard and Jan Mayen\"  class=\"choice-219 depth-1\"  >Svalbard and Jan Mayen<\/option><option value=\"Sweden\"  class=\"choice-220 depth-1\"  >Sweden<\/option><option value=\"Switzerland\"  class=\"choice-221 depth-1\"  >Switzerland<\/option><option value=\"Syrian Arab Republic\"  class=\"choice-222 depth-1\"  >Syrian Arab Republic<\/option><option value=\"Taiwan (Province of China)\"  class=\"choice-223 depth-1\"  >Taiwan (Province of China)<\/option><option value=\"Tajikistan\"  class=\"choice-224 depth-1\"  >Tajikistan<\/option><option value=\"Tanzania, United Republic of\"  class=\"choice-225 depth-1\"  >Tanzania, United Republic of<\/option><option value=\"Thailand\"  class=\"choice-226 depth-1\"  >Thailand<\/option><option value=\"Timor-Leste\"  class=\"choice-227 depth-1\"  >Timor-Leste<\/option><option value=\"Togo\"  class=\"choice-228 depth-1\"  >Togo<\/option><option value=\"Tokelau\"  class=\"choice-229 depth-1\"  >Tokelau<\/option><option value=\"Tonga\"  class=\"choice-230 depth-1\"  >Tonga<\/option><option value=\"Trinidad and Tobago\"  class=\"choice-231 depth-1\"  >Trinidad and Tobago<\/option><option value=\"Tunisia\"  class=\"choice-232 depth-1\"  >Tunisia<\/option><option value=\"Turkey\"  class=\"choice-233 depth-1\"  >Turkey<\/option><option value=\"Turkmenistan\"  class=\"choice-234 depth-1\"  >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\"  class=\"choice-235 depth-1\"  >Turks and Caicos Islands<\/option><option value=\"Tuvalu\"  class=\"choice-236 depth-1\"  >Tuvalu<\/option><option value=\"Uganda\"  class=\"choice-237 depth-1\"  >Uganda<\/option><option value=\"Ukraine\"  class=\"choice-238 depth-1\"  >Ukraine<\/option><option value=\"United Arab Emirates\"  class=\"choice-239 depth-1\"  >United Arab Emirates<\/option><option value=\"United Kingdom of Great Britain and Northern Ireland\"  class=\"choice-240 depth-1\"  >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"United States Minor Outlying Islands\"  class=\"choice-241 depth-1\"  >United States Minor Outlying Islands<\/option><option value=\"United States of America\"  class=\"choice-242 depth-1\"  >United States of America<\/option><option value=\"Uruguay\"  class=\"choice-243 depth-1\"  >Uruguay<\/option><option value=\"Uzbekistan\"  class=\"choice-244 depth-1\"  >Uzbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-245 depth-1\"  >Vanuatu<\/option><option value=\"Venezuela (Bolivarian Republic of)\"  class=\"choice-246 depth-1\"  >Venezuela (Bolivarian Republic of)<\/option><option value=\"Viet Nam\"  class=\"choice-247 depth-1\"  >Vietnam<\/option><option value=\"Virgin Islands (British)\"  class=\"choice-248 depth-1\"  >Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\"  class=\"choice-249 depth-1\"  >Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\"  class=\"choice-250 depth-1\"  >Wallis and Futuna<\/option><option value=\"Western Sahara\"  class=\"choice-251 depth-1\"  >Western Sahara<\/option><option value=\"Yemen\"  class=\"choice-252 depth-1\"  >Yemen<\/option><option value=\"Zambia\"  class=\"choice-253 depth-1\"  >Zambia<\/option><option value=\"Zimbabwe\"  class=\"choice-254 depth-1\"  >Zimbabwe<\/option><\/select><\/div><div id=\"wpforms-14032-field_38-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"38\"><div id=\"wpforms-14032-field_38\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-14032-field_38-error\"><h4><b><span class=\"size\">Billing address<\/span><\/b><\/h4>\n<div><i>To ensure traceability of medical equipment.<\/i><i><br \/>\n<\/i><\/div>\n<div><i>You will not be billed without your agreement.<\/i><\/div>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-14032-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_50\">Intracommunity VAT<\/label><input type=\"text\" id=\"wpforms-14032-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-14032-field_50-error\" aria-describedby=\"wpforms-14032-field_50-description\" ><div id=\"wpforms-14032-field_50-description\" class=\"wpforms-field-description\">If applicable...<\/div><\/div><div id=\"wpforms-14032-field_39-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"39\"><fieldset><legend class=\"wpforms-field-label\">Invoice address same as delivery address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-14032-field_39\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-14032-field_39_1\" name=\"wpforms[fields][39]\" value=\"Yes\" aria-errormessage=\"wpforms-14032-field_39_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_39_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-14032-field_39_2\" name=\"wpforms[fields][39]\" value=\"No\" aria-errormessage=\"wpforms-14032-field_39_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_39_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-14032-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_40\">Street (billing)<\/label><input type=\"text\" id=\"wpforms-14032-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-14032-field_40-error\" ><\/div><div id=\"wpforms-14032-field_41-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_41\">Code (billing)<\/label><input type=\"text\" id=\"wpforms-14032-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-14032-field_41-error\" ><\/div><div id=\"wpforms-14032-field_42-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_42\">City (billing)<\/label><input type=\"text\" id=\"wpforms-14032-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-14032-field_42-error\" ><\/div><div id=\"wpforms-14032-field_43-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_43\">Country (billing)<\/label><select id=\"wpforms-14032-field_43\" class=\"wpforms-field-large\" name=\"wpforms[fields][43]\"><option value=\"Belg\u00efe\"  class=\"choice-4 depth-1\"  >Belgium<\/option><option value=\"Belgique\"  class=\"choice-5 depth-1\"  >Belgium<\/option><option value=\"Belgium\"  class=\"choice-6 depth-1\"  >Belgium<\/option><option value=\"France\"  class=\"choice-7 depth-1\"  >France<\/option><option value=\"Afghanistan\"  class=\"choice-8 depth-1\"  >Afghanistan<\/option><option value=\"\u00c5land Islands\"  class=\"choice-9 depth-1\"  >\u00c5land Islands<\/option><option value=\"Albania\"  class=\"choice-10 depth-1\"  >Albania<\/option><option value=\"Algeria\"  class=\"choice-11 depth-1\"  >Algeria<\/option><option value=\"American Samoa\"  class=\"choice-12 depth-1\"  >American Samoa<\/option><option value=\"Andorra\"  class=\"choice-13 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-14 depth-1\"  >Angola<\/option><option value=\"Anguilla\"  class=\"choice-15 depth-1\"  >Anguilla<\/option><option value=\"Antarctica\"  class=\"choice-16 depth-1\"  >Antarctica<\/option><option value=\"Antigua and Barbuda\"  class=\"choice-17 depth-1\"  >Antigua and Barbuda<\/option><option value=\"Argentina\"  class=\"choice-18 depth-1\"  >Argentina<\/option><option value=\"Armenia\"  class=\"choice-19 depth-1\"  >Armenia<\/option><option value=\"Aruba\"  class=\"choice-20 depth-1\"  >Aruba<\/option><option value=\"Australia\"  class=\"choice-21 depth-1\"  >Australia<\/option><option value=\"Austria\"  class=\"choice-22 depth-1\"  >Austria<\/option><option value=\"Azerbaijan\"  class=\"choice-23 depth-1\"  >Azerbaijan<\/option><option value=\"Bahamas\"  class=\"choice-24 depth-1\"  >Bahamas<\/option><option value=\"Bahrain\"  class=\"choice-25 depth-1\"  >Bahrain<\/option><option value=\"Bangladesh\"  class=\"choice-26 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-27 depth-1\"  >Barbados<\/option><option value=\"Belarus\"  class=\"choice-28 depth-1\"  >Belarus<\/option><option value=\"Belize\"  class=\"choice-29 depth-1\"  >Belize<\/option><option value=\"Benin\"  class=\"choice-30 depth-1\"  >Benin<\/option><option value=\"Bermuda\"  class=\"choice-31 depth-1\"  >Bermuda<\/option><option value=\"Bhutan\"  class=\"choice-32 depth-1\"  >Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\"  class=\"choice-33 depth-1\"  >Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Sint Eustatius and Saba\"  class=\"choice-34 depth-1\"  >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\"  class=\"choice-35 depth-1\"  >Bosnia-Herzegovina<\/option><option value=\"Botswana\"  class=\"choice-36 depth-1\"  >Botswana<\/option><option value=\"Bouvet Island\"  class=\"choice-37 depth-1\"  >Bouvet Island<\/option><option value=\"Brazil\"  class=\"choice-38 depth-1\"  >Brazil<\/option><option value=\"Brunei Darussalam\"  class=\"choice-39 depth-1\"  >Brunei Darussalam<\/option><option value=\"Bulgaria\"  class=\"choice-40 depth-1\"  >Bulgaria<\/option><option value=\"Burkina Faso\"  class=\"choice-41 depth-1\"  >Burkina Faso<\/option><option value=\"Burundi\"  class=\"choice-42 depth-1\"  >Burundi<\/option><option value=\"Cabo Verde\"  class=\"choice-43 depth-1\"  >Cape Verde<\/option><option value=\"Cambodia\"  class=\"choice-44 depth-1\"  >Cambodia<\/option><option value=\"Cameroon\"  class=\"choice-45 depth-1\"  >Cameroon<\/option><option value=\"Canada\"  class=\"choice-46 depth-1\"  >Canada<\/option><option value=\"Cayman Islands\"  class=\"choice-47 depth-1\"  >Cayman Islands<\/option><option value=\"Central African Republic\"  class=\"choice-48 depth-1\"  >Central African Republic<\/option><option value=\"Chad\"  class=\"choice-49 depth-1\"  >Chad<\/option><option value=\"Chile\"  class=\"choice-50 depth-1\"  >Chile<\/option><option value=\"China\"  class=\"choice-51 depth-1\"  >China<\/option><option value=\"Christmas Island\"  class=\"choice-52 depth-1\"  >Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\"  class=\"choice-53 depth-1\"  >Cocos Islands (Keeling)<\/option><option value=\"Colombia\"  class=\"choice-54 depth-1\"  >Colombia<\/option><option value=\"Comoros\"  class=\"choice-55 depth-1\"  >Comoros<\/option><option value=\"Congo\"  class=\"choice-56 depth-1\"  >Congo<\/option><option value=\"Congo, Democratic Republic of the\"  class=\"choice-57 depth-1\"  >Democratic Republic of the Congo<\/option><option value=\"Cook Islands\"  class=\"choice-58 depth-1\"  >Cook Islands<\/option><option value=\"Costa Rica\"  class=\"choice-59 depth-1\"  >Costa Rica<\/option><option value=\"Croatia\"  class=\"choice-60 depth-1\"  >Croatia<\/option><option value=\"Cuba\"  class=\"choice-61 depth-1\"  >Cuba<\/option><option value=\"Cura\u00e7ao\"  class=\"choice-62 depth-1\"  >Cura\u00e7ao<\/option><option value=\"Cyprus\"  class=\"choice-63 depth-1\"  >Cyprus<\/option><option value=\"Czech Republic\"  class=\"choice-64 depth-1\"  >Czech Republic<\/option><option value=\"C\u00f4te d\u2019Ivoire\"  class=\"choice-65 depth-1\"  >C\u00f4te d'Ivoire<\/option><option value=\"Denmark\"  class=\"choice-66 depth-1\"  >Denmark<\/option><option value=\"Djibouti\"  class=\"choice-67 depth-1\"  >Djibouti<\/option><option value=\"Dominica\"  class=\"choice-68 depth-1\"  >Dominique<\/option><option value=\"Dominican Republic\"  class=\"choice-69 depth-1\"  >Dominican Republic<\/option><option value=\"Ecuador\"  class=\"choice-70 depth-1\"  >Ecuador<\/option><option value=\"Egypt\"  class=\"choice-71 depth-1\"  >Egypt<\/option><option value=\"El Salvador\"  class=\"choice-72 depth-1\"  >El Salvador<\/option><option value=\"Equatorial Guinea\"  class=\"choice-73 depth-1\"  >Equatorial Guinea<\/option><option value=\"Eritrea\"  class=\"choice-74 depth-1\"  >Eritrea<\/option><option value=\"Estonia\"  class=\"choice-75 depth-1\"  >Estonia<\/option><option value=\"Eswatini\"  class=\"choice-76 depth-1\"  >Eswatini<\/option><option value=\"Ethiopia\"  class=\"choice-77 depth-1\"  >Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\"  class=\"choice-78 depth-1\"  >Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\"  class=\"choice-79 depth-1\"  >Faroe Islands<\/option><option value=\"Fiji\"  class=\"choice-80 depth-1\"  >Fiji<\/option><option value=\"Finland\"  class=\"choice-81 depth-1\"  >Finland<\/option><option value=\"French Guiana\"  class=\"choice-82 depth-1\"  >French Guiana<\/option><option value=\"French Polynesia\"  class=\"choice-83 depth-1\"  >French Polynesia<\/option><option value=\"French Southern Territories\"  class=\"choice-84 depth-1\"  >French Southern Territories<\/option><option value=\"Gabon\"  class=\"choice-85 depth-1\"  >Gabon<\/option><option value=\"Gambia\"  class=\"choice-86 depth-1\"  >Gambia<\/option><option value=\"Georgia\"  class=\"choice-87 depth-1\"  >Georgia<\/option><option value=\"Germany\"  class=\"choice-88 depth-1\"  >Germany<\/option><option value=\"Ghana\"  class=\"choice-89 depth-1\"  >Ghana<\/option><option value=\"Gibraltar\"  class=\"choice-90 depth-1\"  >Gibraltar<\/option><option value=\"Greece\"  class=\"choice-91 depth-1\"  >Greece<\/option><option value=\"Greenland\"  class=\"choice-92 depth-1\"  >Greenland<\/option><option value=\"Grenada\"  class=\"choice-93 depth-1\"  >Granada<\/option><option value=\"Guadeloupe\"  class=\"choice-94 depth-1\"  >Guadeloupe<\/option><option value=\"Guam\"  class=\"choice-95 depth-1\"  >Guam<\/option><option value=\"Guatemala\"  class=\"choice-96 depth-1\"  >Guatemala<\/option><option value=\"Guernsey\"  class=\"choice-97 depth-1\"  >Guernsey<\/option><option value=\"Guinea\"  class=\"choice-98 depth-1\"  >Guinea<\/option><option value=\"Guinea-Bissau\"  class=\"choice-99 depth-1\"  >Guinea-Bissau<\/option><option value=\"Guyana\"  class=\"choice-100 depth-1\"  >Guyana<\/option><option value=\"Haiti\"  class=\"choice-101 depth-1\"  >Haiti<\/option><option value=\"Heard Island and McDonald Islands\"  class=\"choice-102 depth-1\"  >Heard Island and McDonald Islands<\/option><option value=\"Holy See\"  class=\"choice-103 depth-1\"  >Holy See<\/option><option value=\"Honduras\"  class=\"choice-104 depth-1\"  >Honduras<\/option><option value=\"Hong Kong\"  class=\"choice-105 depth-1\"  >Hong Kong<\/option><option value=\"Hungary\"  class=\"choice-106 depth-1\"  >Hungary<\/option><option value=\"Iceland\"  class=\"choice-107 depth-1\"  >Iceland<\/option><option value=\"India\"  class=\"choice-108 depth-1\"  >India<\/option><option value=\"Indonesia\"  class=\"choice-109 depth-1\"  >Indonesia<\/option><option value=\"Iran (Islamic Republic of)\"  class=\"choice-110 depth-1\"  >Iran (Islamic Republic of)<\/option><option value=\"Iraq\"  class=\"choice-111 depth-1\"  >Iraq<\/option><option value=\"Ireland\"  class=\"choice-112 depth-1\"  >Ireland<\/option><option value=\"Isle of Man\"  class=\"choice-113 depth-1\"  >Isle of Man<\/option><option value=\"Israel\"  class=\"choice-114 depth-1\"  >Israel<\/option><option value=\"Italy\"  class=\"choice-115 depth-1\"  >Italy<\/option><option value=\"Jamaica\"  class=\"choice-116 depth-1\"  >Jamaica<\/option><option value=\"Japan\"  class=\"choice-117 depth-1\"  >Japan<\/option><option value=\"Jersey\"  class=\"choice-118 depth-1\"  >Jersey<\/option><option value=\"Jordan\"  class=\"choice-119 depth-1\"  >Jordan<\/option><option value=\"Kazakhstan\"  class=\"choice-120 depth-1\"  >Kazakhstan<\/option><option value=\"Kenya\"  class=\"choice-121 depth-1\"  >Kenya<\/option><option value=\"Kiribati\"  class=\"choice-122 depth-1\"  >Kiribati<\/option><option value=\"Korea (Democratic People\u2019s Republic of)\"  class=\"choice-123 depth-1\"  >Korea (Democratic People's Republic of)<\/option><option value=\"Korea (Republic of)\"  class=\"choice-124 depth-1\"  >Korea (Republic of)<\/option><option value=\"Kuwait\"  class=\"choice-125 depth-1\"  >Kuwait<\/option><option value=\"Kyrgyzstan\"  class=\"choice-126 depth-1\"  >Kyrgyzstan<\/option><option value=\"Lao People\u2019s Democratic Republic\"  class=\"choice-127 depth-1\"  >Lao People's Democratic Republic<\/option><option value=\"Latvia\"  class=\"choice-128 depth-1\"  >Latvia<\/option><option value=\"Lebanon\"  class=\"choice-129 depth-1\"  >Lebanon<\/option><option value=\"Lesotho\"  class=\"choice-130 depth-1\"  >Lesotho<\/option><option value=\"Liberia\"  class=\"choice-131 depth-1\"  >Liberia<\/option><option value=\"Libya\"  class=\"choice-132 depth-1\"  >Libya<\/option><option value=\"Liechtenstein\"  class=\"choice-133 depth-1\"  >Liechtenstein<\/option><option value=\"Lithuania\"  class=\"choice-134 depth-1\"  >Lithuania<\/option><option value=\"Luxembourg\"  class=\"choice-135 depth-1\"  >Luxembourg<\/option><option value=\"Macao\"  class=\"choice-136 depth-1\"  >Macau<\/option><option value=\"Madagascar\"  class=\"choice-137 depth-1\"  >Madagascar<\/option><option value=\"Malawi\"  class=\"choice-138 depth-1\"  >Malawi<\/option><option value=\"Malaysia\"  class=\"choice-139 depth-1\"  >Malaysia<\/option><option value=\"Maldives\"  class=\"choice-140 depth-1\"  >Maldives<\/option><option value=\"Mali\"  class=\"choice-141 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-142 depth-1\"  >Malta<\/option><option value=\"Marshall Islands\"  class=\"choice-143 depth-1\"  >Marshall Islands<\/option><option value=\"Martinique\"  class=\"choice-144 depth-1\"  >Martinique<\/option><option value=\"Mauritania\"  class=\"choice-145 depth-1\"  >Mauritania<\/option><option value=\"Mauritius\"  class=\"choice-146 depth-1\"  >Mauritius<\/option><option value=\"Mayotte\"  class=\"choice-147 depth-1\"  >Mayotte<\/option><option value=\"Mexico\"  class=\"choice-148 depth-1\"  >Mexico<\/option><option value=\"Micronesia (Federated States of)\"  class=\"choice-149 depth-1\"  >Micronesia (Federated States of)<\/option><option value=\"Moldova (Republic of)\"  class=\"choice-150 depth-1\"  >Moldova (Republic of)<\/option><option value=\"Monaco\"  class=\"choice-151 depth-1\"  >Monaco<\/option><option value=\"Mongolia\"  class=\"choice-152 depth-1\"  >Mongolia<\/option><option value=\"Montenegro\"  class=\"choice-153 depth-1\"  >Montenegro<\/option><option value=\"Montserrat\"  class=\"choice-154 depth-1\"  >Montserrat<\/option><option value=\"Morocco\"  class=\"choice-155 depth-1\"  >Morocco<\/option><option value=\"Mozambique\"  class=\"choice-156 depth-1\"  >Mozambique<\/option><option value=\"Myanmar\"  class=\"choice-157 depth-1\"  >Myanmar<\/option><option value=\"Namibia\"  class=\"choice-158 depth-1\"  >Namibia<\/option><option value=\"Nauru\"  class=\"choice-159 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-160 depth-1\"  >Nepal<\/option><option value=\"Netherlands\"  class=\"choice-161 depth-1\"  >Netherlands<\/option><option value=\"New Caledonia\"  class=\"choice-162 depth-1\"  >New Caledonia<\/option><option value=\"New Zealand\"  class=\"choice-163 depth-1\"  >New Zealand<\/option><option value=\"Nicaragua\"  class=\"choice-164 depth-1\"  >Nicaragua<\/option><option value=\"Niger\"  class=\"choice-165 depth-1\"  >Niger<\/option><option value=\"Nigeria\"  class=\"choice-166 depth-1\"  >Nigeria<\/option><option value=\"Niue\"  class=\"choice-167 depth-1\"  >Niue<\/option><option value=\"Norfolk Island\"  class=\"choice-168 depth-1\"  >Norfolk Island<\/option><option value=\"North Macedonia (former Yugoslav Republic of)\"  class=\"choice-169 depth-1\"  >North Macedonia (former Yugoslav Republic of)<\/option><option value=\"Northern Mariana Islands\"  class=\"choice-170 depth-1\"  >Northern Mariana Islands<\/option><option value=\"Norway\"  class=\"choice-171 depth-1\"  >Norway<\/option><option value=\"Oman\"  class=\"choice-172 depth-1\"  >Oman<\/option><option value=\"Pakistan\"  class=\"choice-173 depth-1\"  >Pakistan<\/option><option value=\"Palau\"  class=\"choice-174 depth-1\"  >Palau<\/option><option value=\"Palestine, State of\"  class=\"choice-175 depth-1\"  >Palestine, State of<\/option><option value=\"Panama\"  class=\"choice-176 depth-1\"  >Panama<\/option><option value=\"Papua New Guinea\"  class=\"choice-177 depth-1\"  >Papua New Guinea<\/option><option value=\"Paraguay\"  class=\"choice-178 depth-1\"  >Paraguay<\/option><option value=\"Peru\"  class=\"choice-179 depth-1\"  >Peru<\/option><option value=\"Philippines\"  class=\"choice-180 depth-1\"  >Philippines<\/option><option value=\"Pitcairn\"  class=\"choice-181 depth-1\"  >Pitcairn<\/option><option value=\"Poland\"  class=\"choice-182 depth-1\"  >Poland<\/option><option value=\"Portugal\"  class=\"choice-183 depth-1\"  >Portugal<\/option><option value=\"Puerto Rico\"  class=\"choice-184 depth-1\"  >Puerto Rico<\/option><option value=\"Qatar\"  class=\"choice-185 depth-1\"  >Qatar<\/option><option value=\"R\u00e9union\"  class=\"choice-186 depth-1\"  >R\u00e9union<\/option><option value=\"Romania\"  class=\"choice-187 depth-1\"  >Romania<\/option><option value=\"Russian Federation\"  class=\"choice-188 depth-1\"  >Russian Federation<\/option><option value=\"Rwanda\"  class=\"choice-189 depth-1\"  >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\"  class=\"choice-190 depth-1\"  >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\"  class=\"choice-191 depth-1\"  >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\"  class=\"choice-192 depth-1\"  >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\"  class=\"choice-193 depth-1\"  >Saint Lucia<\/option><option value=\"Saint Martin (French part)\"  class=\"choice-194 depth-1\"  >Saint-Martin (French part)<\/option><option value=\"Saint Martin (Dutch part)\"  class=\"choice-195 depth-1\"  >Sint Maarten (Dutch part)<\/option><option value=\"Saint Pierre and Miquelon\"  class=\"choice-196 depth-1\"  >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\"  class=\"choice-197 depth-1\"  >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\"  class=\"choice-198 depth-1\"  >Samoa<\/option><option value=\"San Marino\"  class=\"choice-199 depth-1\"  >San Marino<\/option><option value=\"Sao Tome and Principe\"  class=\"choice-200 depth-1\"  >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\"  class=\"choice-201 depth-1\"  >Saudi Arabia<\/option><option value=\"Senegal\"  class=\"choice-202 depth-1\"  >Senegal<\/option><option value=\"Serbia\"  class=\"choice-203 depth-1\"  >Serbia<\/option><option value=\"Seychelles\"  class=\"choice-204 depth-1\"  >Seychelles<\/option><option value=\"Sierra Leone\"  class=\"choice-205 depth-1\"  >Sierra Leone<\/option><option value=\"Singapore\"  class=\"choice-206 depth-1\"  >Singapore<\/option><option value=\"Sint Maarten (Dutch part)\"  class=\"choice-207 depth-1\"  >Sint Martin (Dutch part)<\/option><option value=\"Slovakia\"  class=\"choice-208 depth-1\"  >Slovakia<\/option><option value=\"Slovenia\"  class=\"choice-209 depth-1\"  >Slovenia<\/option><option value=\"Solomon Islands\"  class=\"choice-210 depth-1\"  >Solomon Islands<\/option><option value=\"Somalia\"  class=\"choice-211 depth-1\"  >Somalia<\/option><option value=\"South Africa\"  class=\"choice-212 depth-1\"  >South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\"  class=\"choice-213 depth-1\"  >South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\"  class=\"choice-214 depth-1\"  >South Sudan<\/option><option value=\"Spain\"  class=\"choice-215 depth-1\"  >Spain<\/option><option value=\"Sri Lanka\"  class=\"choice-216 depth-1\"  >Sri Lanka<\/option><option value=\"Sudan\"  class=\"choice-217 depth-1\"  >Sudan<\/option><option value=\"Suriname\"  class=\"choice-218 depth-1\"  >Suriname<\/option><option value=\"Svalbard and Jan Mayen\"  class=\"choice-219 depth-1\"  >Svalbard and Jan Mayen<\/option><option value=\"Sweden\"  class=\"choice-220 depth-1\"  >Sweden<\/option><option value=\"Switzerland\"  class=\"choice-221 depth-1\"  >Switzerland<\/option><option value=\"Syrian Arab Republic\"  class=\"choice-222 depth-1\"  >Syrian Arab Republic<\/option><option value=\"Taiwan (Province of China)\"  class=\"choice-223 depth-1\"  >Taiwan (Province of China)<\/option><option value=\"Tajikistan\"  class=\"choice-224 depth-1\"  >Tajikistan<\/option><option value=\"Tanzania, United Republic of\"  class=\"choice-225 depth-1\"  >Tanzania, United Republic of<\/option><option value=\"Thailand\"  class=\"choice-226 depth-1\"  >Thailand<\/option><option value=\"Timor-Leste\"  class=\"choice-227 depth-1\"  >Timor-Leste<\/option><option value=\"Togo\"  class=\"choice-228 depth-1\"  >Togo<\/option><option value=\"Tokelau\"  class=\"choice-229 depth-1\"  >Tokelau<\/option><option value=\"Tonga\"  class=\"choice-230 depth-1\"  >Tonga<\/option><option value=\"Trinidad and Tobago\"  class=\"choice-231 depth-1\"  >Trinidad and Tobago<\/option><option value=\"Tunisia\"  class=\"choice-232 depth-1\"  >Tunisia<\/option><option value=\"Turkey\"  class=\"choice-233 depth-1\"  >Turkey<\/option><option value=\"Turkmenistan\"  class=\"choice-234 depth-1\"  >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\"  class=\"choice-235 depth-1\"  >Turks and Caicos Islands<\/option><option value=\"Tuvalu\"  class=\"choice-236 depth-1\"  >Tuvalu<\/option><option value=\"Uganda\"  class=\"choice-237 depth-1\"  >Uganda<\/option><option value=\"Ukraine\"  class=\"choice-238 depth-1\"  >Ukraine<\/option><option value=\"United Arab Emirates\"  class=\"choice-239 depth-1\"  >United Arab Emirates<\/option><option value=\"United Kingdom of Great Britain and Northern Ireland\"  class=\"choice-240 depth-1\"  >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"United States Minor Outlying Islands\"  class=\"choice-241 depth-1\"  >United States Minor Outlying Islands<\/option><option value=\"United States of America\"  class=\"choice-242 depth-1\"  >United States of America<\/option><option value=\"Uruguay\"  class=\"choice-243 depth-1\"  >Uruguay<\/option><option value=\"Uzbekistan\"  class=\"choice-244 depth-1\"  >Uzbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-245 depth-1\"  >Vanuatu<\/option><option value=\"Venezuela (Bolivarian Republic of)\"  class=\"choice-246 depth-1\"  >Venezuela (Bolivarian Republic of)<\/option><option value=\"Viet Nam\"  class=\"choice-247 depth-1\"  >Vietnam<\/option><option value=\"Virgin Islands (British)\"  class=\"choice-248 depth-1\"  >Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\"  class=\"choice-249 depth-1\"  >Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\"  class=\"choice-250 depth-1\"  >Wallis and Futuna<\/option><option value=\"Western Sahara\"  class=\"choice-251 depth-1\"  >Western Sahara<\/option><option value=\"Yemen\"  class=\"choice-252 depth-1\"  >Yemen<\/option><option value=\"Zambia\"  class=\"choice-253 depth-1\"  >Zambia<\/option><option value=\"Zimbabwe\"  class=\"choice-254 depth-1\"  >Zimbabwe<\/option><\/select><\/div><div id=\"wpforms-14032-field_45-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_45\">Why test the Wheeleo\u00ae? With which patient profile? In which departments?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-14032-field_45\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-14032-field_45-error\" required><\/textarea><\/div><div id=\"wpforms-14032-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_46\">How did you obtain the link to this convention? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-14032-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" aria-errormessage=\"wpforms-14032-field_46-error\" required><\/textarea><\/div><div id=\"wpforms-14032-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_47\">Which medical equipment retailers do you work with on a regular basis?<\/label><textarea id=\"wpforms-14032-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-14032-field_47-error\" ><\/textarea><\/div><div id=\"wpforms-14032-field_48-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_48\">Start date : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-14032-field_48\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][48][date]\" aria-errormessage=\"wpforms-14032-field_48-error\" aria-describedby=\"wpforms-14032-field_48-description\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><div id=\"wpforms-14032-field_48-description\" class=\"wpforms-field-description\">The training\/presentation (online) must be organized before starting the test.<\/div><\/div><div id=\"wpforms-14032-field_49-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"49\"><fieldset><legend class=\"wpforms-field-label\">Conditions <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-14032-field_49\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-14032-field_49_1\" name=\"wpforms[fields][49][]\" value=\"I hereby accept the Wheeleo\u00ae test conditions:\" aria-errormessage=\"wpforms-14032-field_49_1-error\" aria-describedby=\"wpforms-14032-field_49-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_49_1\">I hereby accept the Wheeleo\u00ae test conditions:<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-14032-field_49_2\" name=\"wpforms[fields][49][]\" value=\"I agree that InnoRehab SRL may use my personal information to communicate with me regarding my request and its other services.\" aria-errormessage=\"wpforms-14032-field_49_2-error\" aria-describedby=\"wpforms-14032-field_49-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-14032-field_49_2\">I agree that InnoRehab SRL may use my personal information to communicate with me regarding my request and its other services.<\/label><\/li><\/ul><div id=\"wpforms-14032-field_49-description\" class=\"wpforms-field-description\">\u2022 2-week test period \u2022 Return at Wheeleo\u00ae's expense (in original packaging) \u2022 Online presentation to be followed, regular contact during the test period and complete feedback to be provided at the end of the test \u2022 After the test: purchase or return \u2022 My institution has the ability to place an order directly without going through a tender process or framework agreement.<\/div><\/fieldset><\/div><div id=\"wpforms-14032-field_9-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-14032-field_9\">Message<\/label><textarea id=\"wpforms-14032-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-14032-field_9-error\" ><\/textarea><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-14032-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-14032-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-14032-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"14032\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/pages\/5131\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-14032\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Send\" aria-live=\"assertive\" value=\"wpforms-submit\">Send<\/button><img decoding=\"async\" src=\"https:\/\/www.wheeleo.eu\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-95b4521 e-flex e-con-boxed e-con e-parent\" data-id=\"95b4521\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e240822 elementor-widget elementor-widget-text-editor\" data-id=\"e240822\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h2><strong>Need more information?<\/strong><\/h2><p><strong>Contact <\/strong><b>Geoffroy Dellicour<\/b>,<\/p><div>Physiotherapist and Wheeleo\u00ae designer<\/div><div><a href=\"mailto:geoffroy@wheeleo.eu\">geoffroy@wheeleo.eu<\/a><\/div><div>+32479728897<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>To test is to adopt You have expressed an interest in the Wheeleo\u00ae and would like to obtain a copy to observe its effect in your department\/institution\/cabinet. InnoRehab offers to send you a free Wheeleo\u00ae walking aid companion so that you can test it for a period of 2 weeks. Get a test Proposal: We [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-5131","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/pages\/5131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/comments?post=5131"}],"version-history":[{"count":2,"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/pages\/5131\/revisions"}],"predecessor-version":[{"id":14045,"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/pages\/5131\/revisions\/14045"}],"wp:attachment":[{"href":"https:\/\/www.wheeleo.eu\/en\/wp-json\/wp\/v2\/media?parent=5131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}