{"id":29299,"date":"2025-10-08T09:58:16","date_gmt":"2025-10-08T13:58:16","guid":{"rendered":"https:\/\/rubanrose.wpbeta.vortexdev.com\/?page_id=29299"},"modified":"2026-01-13T14:28:18","modified_gmt":"2026-01-13T19:28:18","slug":"service-eligibility-form","status":"publish","type":"page","link":"https:\/\/rubanrose.wpbeta.vortexdev.com\/en\/support-me\/support-services\/service-eligibility-form\/","title":{"rendered":"Service Eligibility Form"},"content":{"rendered":"<section class=\"gravity-forms-block aligndefault\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_28' style='display:none'><div id='gf_28' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_28' id='gform_28'  action='\/en\/wp-json\/wp\/v2\/pages\/29299#gf_28' data-formid='28' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcsPxkpAAAAANBWucAm5XtMHiHX-byecgHN0W0u' data-tabindex='0'><input id=\"input_b3f32fc08e9b23d08a2827d6d5261130\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_b3f32fc08e9b23d08a2827d6d5261130\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_28' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_28_187\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--honeypot\"  data-field-class=\"gfield--honeypot\" ><label class='gfield_label gform-field-label' for='input_28_187'>X\/Twitter<\/label><div class='gfield_description' id='gfield_description_28_187'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_187' id='input_28_187' type='text' value='' autocomplete='new-password'\/><\/div><\/div><fieldset id=\"field_28_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Avez-vous re\u00e7u un diagnostic de cancer du sein?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_3'>\n\t\t\t<div class='gchoice gchoice_28_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Oui'  id='choice_28_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_3_0' id='label_28_3_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Non'  id='choice_28_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_3_1' id='label_28_3_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_149\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--section gfield--section\"  data-field-class=\"gfield--section gfield--section\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">SECTION DIAGNOSTIC CANCER DU SEIN &#8211; NON<\/h3><\/div><fieldset id=\"field_28_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >\u00cates-vous un proche d&#039;une personne touch\u00e9e par le cancer du sein?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_64'>\n\t\t\t<div class='gchoice gchoice_28_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Oui'  id='choice_28_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_64_0' id='label_28_64_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Non'  id='choice_28_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_64_1' id='label_28_64_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_66\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Vous n&#8217;\u00eates pas admissible \u00e0 nos services. Nos services sont r\u00e9serv\u00e9s aux personnes atteintes par le cancer du sein et leurs proches.<\/strong><\/p>\n\n<p>Si vous avez des questions ou inqui\u00e9tudes concernant le cancer du sein et souhaitez recevoir de l&#8217;\u00e9coute, vous pouvez parler \u00e0 une personne de confiance gr\u00e2ce \u00e0 notre Ligne Rose. Cette ligne d&#8217;\u00e9coute est offerte en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n\n<p><strong>Appelez-nous au 1-855-561-ROSE (7673)\u2028<br>\nDu lundi au vendredi, de 9 h \u00e0 17 h.<\/strong><\/p>\n\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, vous pouvez participer \u00e0 certaines activit\u00e9s offertes gratuitement \u00e0 la Maison Rose (voir \u00e9v\u00e9nements pour tous.tes), en <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\">cliquant ici<\/a>.<\/p>\n\n<p>Nous vous invitons \u00e9galement \u00e0 consulter la section <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-minforme\/\">\u00ab Je m\u2019informe \u00bb<\/a> de notre site web pour en apprendre davantage sur le cancer du sein, ses facteurs de risque, ses traitements,  et bien plus!<\/p>\n\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n<\/div><\/div><fieldset id=\"field_28_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >R\u00e9sidez-vous au Qu\u00e9bec?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_1'>\n\t\t\t<div class='gchoice gchoice_28_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Oui'  id='choice_28_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_1_0' id='label_28_1_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Non'  id='choice_28_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_1_1' id='label_28_1_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_2\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Vous n&#8217;\u00eates pas admissible \u00e0 nos services. Nos services sont r\u00e9serv\u00e9s aux personnes r\u00e9sidant au Qu\u00e9bec.<\/strong><\/p>\n\n<p>Nous vous invitons \u00e9galement \u00e0 consulter la section <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-minforme\/\">\u00ab Je m\u2019informe \u00bb<\/a> de notre site web pour en apprendre davantage sur le cancer du sein, ses facteurs de risque, ses traitements,  et bien plus!<\/p>\n\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, vous pouvez participer \u00e0 certaines activit\u00e9s offertes gratuitement \u00e0 la Maison Rose (voir \u00e9v\u00e9nements pour tous.tes), en <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\">cliquant ici<\/a>.<\/p>\n\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n<\/div><\/div><div id=\"field_28_103\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div class=\"dyn-form-container-principal-accordion\">\n\n <p style=\"margin-bottom: 10px; color:black;font-weight:600;\">\nEn tant que proche d\u2019une personne atteinte du cancer du sein, vous avez acc\u00e8s aux services suivants :\n <\/p>  \n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nLigne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\n  Soutien psychosocial\n<\/button>\n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant\u00b7e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nService de conseil g\u00e9n\u00e9tique\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\nMaison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir la Maison Rose, un lieu accueillant et bienveillant. Vous y trouverez des conf\u00e9rences et ateliers gratuits con\u00e7us pour les personnes atteintes et leurs proches, portant sur des th\u00e8mes tels que la proche aidance, la gestion du stress, les ressources disponibles et les avanc\u00e9es m\u00e9dicales en lien avec le cancer du sein.<\/p>  \n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n<p style=\"margin-top: 20px!important;\">N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n<\/div><\/div><fieldset id=\"field_28_105\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_105'><div class='gchoice gchoice_28_105_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_105_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_105_1' id='label_28_105_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_105_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.2' type='checkbox'  value='Conseil g\u00e9n\u00e9tique'  id='choice_28_105_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_105_2' id='label_28_105_2' class='gform-field-label gform-field-label--type-inline'>Conseil g\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_105_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_106\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><fieldset id=\"field_28_160\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_160'>\n\t\t\t<div class='gchoice gchoice_28_160_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='Oui'  id='choice_28_160_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_160_0' id='label_28_160_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_160_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='Non'  id='choice_28_160_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_160_1' id='label_28_160_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_165\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p style=\"font-weight:700px;\">Vous semblez \u00eatre admissible aux services de la Fondation, mais vous avez choisi de ne pas soumettre de demande pour le moment.<\/p>  \n\n<p>En attendant, nous vous invitons \u00e0 consulter la section <a href=\"rubanrose.org\/je-minforme\">Je m&#8217;informe<\/a> de notre site web pour en apprendre davantage sur le cancer du sein, ses facteurs de risque, ses traitements, et bien plus!\n<\/p>  \n\n<\/div><\/div><div id=\"field_28_107\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--section gfield--section\"  data-field-class=\"gfield--section gfield--section\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">SECTION DIAGNOSTIC CANCER DU SEIN &#8211; OUI<\/h3><\/div><fieldset id=\"field_28_108\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >R\u00e9sidez-vous au Qu\u00e9bec?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_108'>\n\t\t\t<div class='gchoice gchoice_28_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Oui'  id='choice_28_108_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_108_0' id='label_28_108_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Non'  id='choice_28_108_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_108_1' id='label_28_108_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_109\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p>Vous n&#8217;\u00eates pas admissible \u00e0 nos services. Nos services sont r\u00e9serv\u00e9s aux personnes r\u00e9sidant au Qu\u00e9bec.<\/p>\n\n<p>Nous vous invitons \u00e9galement \u00e0 consulter la section <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-minforme\/\">\u00ab Je m\u2019informe \u00bb<\/a> de notre site web pour en apprendre davantage sur le cancer du sein, ses facteurs de risque, ses traitements,  et bien plus!<\/p>\n\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, vous pouvez participer \u00e0 certaines activit\u00e9s offertes gratuitement \u00e0 la Maison Rose (voir \u00e9v\u00e9nements pour tous.tes), en <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\">cliquant ici<\/a>.<\/p>\n\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n<\/div><\/div><fieldset id=\"field_28_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Je souhaite<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_5'>\n\t\t\t<div class='gchoice gchoice_28_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Valider mon admissibilit\u00e9 aux services de la Fondation'  id='choice_28_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_5_0' id='label_28_5_0' class='gform-field-label gform-field-label--type-inline'>Valider mon admissibilit\u00e9 aux services de la Fondation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Valider mon admissibilit\u00e9 \u00e0 l&#039;aide financi\u00e8re'  id='choice_28_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_5_1' id='label_28_5_1' class='gform-field-label gform-field-label--type-inline'>Valider mon admissibilit\u00e9 \u00e0 l&#8217;aide financi\u00e8re<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_46\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--section gfield--section\"  data-field-class=\"gfield--section gfield--section\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Valider mon admissibilit\u00e9 aux services de la Fondation<\/h3><\/div><fieldset id=\"field_28_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >\u00c0 quel stade \u00e9tait votre cancer du sein lors de votre dernier diagnostic?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_6'>\n\t\t\t<div class='gchoice gchoice_28_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Stade 0'  id='choice_28_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_0' id='label_28_6_0' class='gform-field-label gform-field-label--type-inline'>Stade 0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Stade 1'  id='choice_28_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_1' id='label_28_6_1' class='gform-field-label gform-field-label--type-inline'>Stade 1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Stade 2'  id='choice_28_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_2' id='label_28_6_2' class='gform-field-label gform-field-label--type-inline'>Stade 2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_6_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Stade 3'  id='choice_28_6_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_3' id='label_28_6_3' class='gform-field-label gform-field-label--type-inline'>Stade 3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_6_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Stade 4'  id='choice_28_6_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_4' id='label_28_6_4' class='gform-field-label gform-field-label--type-inline'>Stade 4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_6_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Je ne sais pas'  id='choice_28_6_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_5' id='label_28_6_5' class='gform-field-label gform-field-label--type-inline'>Je ne sais pas<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_126\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full dateFGD field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--date gfield--date gfield--has-multiple-inputs\"  data-field-class=\"gfield--date gfield--date gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label' >Quelle est la date approximative de votre plus r\u00e9cent diagnostic?<\/legend><div class='gfield_description' id='gfield_description_28_126'>Veuillez saisir la date selon vos meilleures estimations.<\/div><div id='input_28_126' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_28_126_2_container'><label for='input_28_126_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>DD<\/label><select name='input_126[]' id='input_28_126_2'   aria-required='false'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' selected='selected'>28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_28_126_1_container'><label for='input_28_126_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_126[]' id='input_28_126_1'   aria-required='false'  ><option value=''>Mois<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_28_126_3_container'><label for='input_28_126_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_126[]' id='input_28_126_3'   aria-required='false'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_28_127\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--number gfield--number\"  data-field-class=\"gfield--number gfield--number\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_28_127'>Nombre d&#039;ann\u00e9es depuis dernier diagnostic<\/label><div class='ginput_container ginput_container_number'><input name='input_127' id='input_28_127' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_28_30\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n\n<div class=\"dyn-form-container-principal-accordion\">\n <p style=\"margin-bottom: 10px; font-weight:600;\">\n <strong>Afin de valider votre admissibilit\u00e9 \u00e0 nos services, nous aurions besoin de conna\u00eetre le stade de votre cancer du sein. <\/strong> Cette information nous permettra de mieux vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <\/p>\n <p style=\"margin-bottom: 10px;\">En attendant, vous pouvez d\u00e8s maintenant b\u00e9n\u00e9ficier de nos services de soutien, notamment :\n <\/p>  \n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\nLigne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\n  Soutien psychosocial\n<\/button> \n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant\u00b7e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nConseil g\u00e9n\u00e9tique\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nMaison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir la Maison Rose, un lieu accueillant et bienveillant. Vous y trouverez des conf\u00e9rences et ateliers gratuits con\u00e7us pour les personnes atteintes et leurs proches, portant sur des th\u00e8mes tels que la proche aidance, la gestion du stress, les ressources disponibles et les avanc\u00e9es m\u00e9dicales en lien avec le cancer du sein.<\/p>  \n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n\n<div style=\"margin-top: 30px;\">\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n\n<p>N\u2019h\u00e9sitez pas \u00e0 nous \u00e9crire ou \u00e0 nous appeler \u2014 nous sommes l\u00e0 pour vous accompagner, avec bienveillance et confidentialit\u00e9.<\/p>\n<p><strong>T\u00e9l\u00e9phone :<\/strong> 514 871-1717<br>\n<strong>Sans frais :<\/strong> 1 877 990-7171\u2028<br>\ninfo@rubanrose.org<br>\n<\/div>\n<\/div><\/div><fieldset id=\"field_28_110\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_110'><div class='gchoice gchoice_28_110_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_110_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_110_1' id='label_28_110_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_110_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_110.2' type='checkbox'  value='Conseil g\u00e9n\u00e9tique'  id='choice_28_110_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_110_2' id='label_28_110_2' class='gform-field-label gform-field-label--type-inline'>Conseil g\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_110_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_117\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><div id=\"field_28_133\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div class=\"dyn-form-container-principal-accordion\">\n\n <p style=\"margin-bottom: 10px; color:#280062;font-weight:600;\">\nVous \u00eates admissibles aux services suivants :\n <\/p>  \n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nLigne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n<div style=\"margin-bottom: 10px;\">\n\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\n  <div>\n  Soutien psychosocial\n<\/button>\n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant.e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nConseil g\u00e9n\u00e9tique\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nS\u00e9ances de yoga en ligne et en studio\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Des cours de yoga encadr\u00e9s et s\u00e9curitaires, offerts en studio ou virtuellement, sp\u00e9cialement adapt\u00e9s aux personnes touch\u00e9es par le cancer du sein. Anim\u00e9s par des professeur.e.s form\u00e9.e.s et accr\u00e9dit\u00e9.e.s.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/saines-habitudes-de-vie\/ma-sante-active-activite-physique\/yoga\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nSophrologie\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une approche douce et guid\u00e9e combinant respiration, relaxation et pleine conscience, con\u00e7ue pour am\u00e9liorer le bien-\u00eatre physique et \u00e9motionnel. Reconnue comme soin de support en oncologie, elle favorise la s\u00e9r\u00e9nit\u00e9.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/sophrologie\/\n\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nClinique Virtuelle\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Accessible 24\/7, cette plateforme vous permet de consulter gratuitement des m\u00e9decins, infirmier.\u00e8res et autres professionnel.les de la sant\u00e9 \u00e0 distance, en quelques clics, \u00e0 partir de votre t\u00e9l\u00e9phone, tablette ou ordinateur.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-medical\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n<div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nOnco-esth\u00e9tique\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un service doux et personnalis\u00e9 pour les personnes atteintes du cancer du sein, offrant des soins adapt\u00e9s tels que facials, soins du cuir chevelu, manucures et p\u00e9dicures. Ces soins visent \u00e0 soulager les effets des traitements, prendre soin du corps et soutenir l\u2019image de soi dans un cadre bienveillant et s\u00e9curitaire.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/onco-esthetique\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Rencontres anim\u00e9es par un.e travailleur.se social.e sans th\u00e9matiques \u00e9tablies, destin\u00e9es aux personnes ayant re\u00e7u un diagnostic de cancer du sein. Un espace s\u00e9curitaire et confidentiel pour partager, \u00e9changer et briser l\u2019isolement.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#cafe_causerie\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion mensuel avec th\u00e9matique <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un groupe anim\u00e9 par un.e travailleur.se social.e qui aura une th\u00e9matique pr\u00e9-\u00e9tablie diff\u00e9rente \u00e0 chaque mois. Visiter le calendrier de programmation de la Maison Rose afin de connaitre la prochaine th\u00e9matique.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#groupe_discussion_thematique\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nClub Jasette <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Groupe de discussion virtuel anim\u00e9 par un.e travailleur.se social.e, offert deux fois par mois, destin\u00e9 aux personnes vivant avec un cancer du sein m\u00e9tastatique. Ce moment d\u2019\u00e9change entre pair.e. permet de partager son v\u00e9cu avec d\u2019autres personnes qui comprennent bien la r\u00e9alit\u00e9 de la maladie.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#club_jasette_virtuel\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\nMaison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc.<\/p>  \n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n<div style=\"margin-top: 30px;\">\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n\n<p>N\u2019h\u00e9sitez pas \u00e0 nous \u00e9crire ou \u00e0 nous appeler \u2014 nous sommes l\u00e0 pour vous accompagner, avec bienveillance et confidentialit\u00e9.<\/p>\n<p><strong>T\u00e9l\u00e9phone :<\/strong> 514 871-1717<br>\n<strong>Sans frais :<\/strong> 1 877 990-7171\u2028<br>\ninfo@rubanrose.org<br>\n<\/div>\n<\/div><\/div><fieldset id=\"field_28_135\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_135'><div class='gchoice gchoice_28_135_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_135_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_1' id='label_28_135_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.2' type='checkbox'  value='Conseil G\u00e9n\u00e9tique'  id='choice_28_135_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_2' id='label_28_135_2' class='gform-field-label gform-field-label--type-inline'>Conseil G\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.3' type='checkbox'  value='S\u00e9ances de yoga en studio'  id='choice_28_135_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_3' id='label_28_135_3' class='gform-field-label gform-field-label--type-inline'>S\u00e9ances de yoga en studio<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.4' type='checkbox'  value='S\u00e9ances de yoga en ligne'  id='choice_28_135_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_4' id='label_28_135_4' class='gform-field-label gform-field-label--type-inline'>S\u00e9ances de yoga en ligne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.5' type='checkbox'  value='Sophrologie'  id='choice_28_135_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_5' id='label_28_135_5' class='gform-field-label gform-field-label--type-inline'>Sophrologie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.6' type='checkbox'  value='Clinique Virtuelle'  id='choice_28_135_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_6' id='label_28_135_6' class='gform-field-label gform-field-label--type-inline'>Clinique Virtuelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.7' type='checkbox'  value='Onco-esth\u00e9tique'  id='choice_28_135_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_7' id='label_28_135_7' class='gform-field-label gform-field-label--type-inline'>Onco-esth\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.8' type='checkbox'  value='Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)'  id='choice_28_135_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_8' id='label_28_135_8' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.9' type='checkbox'  value='Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)'  id='choice_28_135_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_9' id='label_28_135_9' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.11' type='checkbox'  value='Club Jasette (\u00c0 VENIR)'  id='choice_28_135_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_11' id='label_28_135_11' class='gform-field-label gform-field-label--type-inline'>Club Jasette (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_135_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_134\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><fieldset id=\"field_28_152\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--address gfield--address gfield--has-multiple-inputs\"  data-field-class=\"gfield--address gfield--address gfield--has-multiple-inputs\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez entrer votre code postal<\/legend>    \n                    <div class='ginput_complex ginput_container has_zip ginput_container_address gform-grid-row' id='input_28_152' >\n                        <input type='hidden' class='gform_hidden' name='input_152.4' id='input_28_152_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_28_152_5_container' >\n                                    <input type='text' name='input_152.5' id='input_28_152_5' value=''    aria-required='false'    \/>\n                                    <label for='input_28_152_5' id='input_28_152_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_152.6' id='input_28_152_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_28_114\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div class=\"dyn-form-container-principal-accordion\">\n\n <p style=\"margin-bottom: 10px; color:#280062;font-weight:600;\">\nVous \u00eates admissibles aux services suivants :\n <\/p>  \n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nLigne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\n  Soutien psychosocial\n<\/button>\n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant\u00b7e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nConseil g\u00e9n\u00e9tique\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nS\u00e9ances de yoga en ligne et en studio\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Des cours de yoga encadr\u00e9s et s\u00e9curitaires, offerts en studio ou virtuellement, sp\u00e9cialement adapt\u00e9s aux personnes touch\u00e9es par le cancer du sein. Anim\u00e9s par des professeur.e.s form\u00e9.e.s et accr\u00e9dit\u00e9.e.s.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/saines-habitudes-de-vie\/ma-sante-active-activite-physique\/yoga\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nSophrologie\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une approche douce et guid\u00e9e combinant respiration, relaxation et pleine conscience, con\u00e7ue pour am\u00e9liorer le bien-\u00eatre physique et \u00e9motionnel. Reconnue comme soin de support en oncologie, elle favorise la s\u00e9r\u00e9nit\u00e9.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"\nhttps:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/sophrologie\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nHypnose\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une approche de relaxation profonde et de visualisation guid\u00e9e qui aide \u00e0 apaiser l\u2019anxi\u00e9t\u00e9, \u00e0 soutenir l\u2019adaptation \u00e9motionnelle et \u00e0 retrouver un sentiment de calme int\u00e9rieur. Cette activit\u00e9 s\u2019adresse exclusivement aux personnes terminant leurs traitements ou en r\u00e9mission d\u2019un cancer du sein, afin de les accompagner avec bienveillance dans cette p\u00e9riode de transition et de r\u00e9\u00e9quilibre.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/hypnose\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nOnco-esth\u00e9tique\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un service doux et personnalis\u00e9 pour les personnes atteintes du cancer du sein, offrant des soins adapt\u00e9s tels que facials, soins du cuir chevelu, manucures et p\u00e9dicures. Ces soins visent \u00e0 soulager les effets des traitements, prendre soin du corps et soutenir l\u2019image de soi dans un cadre bienveillant et s\u00e9curitaire.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/onco-esthetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nClinique Virtuelle\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Accessible 24\/7, cette plateforme vous permet de consulter gratuitement des m\u00e9decins, infirmier.\u00e8re.s et autres professionnel.le,s de la sant\u00e9 \u00e0 distance, en quelques clics, \u00e0 partir de votre t\u00e9l\u00e9phone, tablette ou ordinateur.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-medical\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de soutien \u00ab\u00a0Retour au travail \u00bb <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un groupe en ligne anim\u00e9 par un.e travailleur.se social.e pour accompagner les personnes ayant termin\u00e9 leurs traitements actifs et planifiant un retour au travail. Pendant 7 semaines, en petit groupe, les participant.e.s auront l\u2019occasion d\u2019\u00e9changer, de se pr\u00e9parer et de retrouver un meilleur \u00e9quilibre professionnel.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#groupe_retour_travail\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Rencontres anim\u00e9es par un.e travailleur.se social.e sans th\u00e9matiques \u00e9tablies, destin\u00e9es aux personnes ayant re\u00e7u un diagnostic de cancer du sein. Un espace s\u00e9curitaire et confidentiel pour partager, \u00e9changer et briser l\u2019isolement.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#cafe_causerie\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion mensuel avec th\u00e9matique <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un groupe anim\u00e9 par un.e travailleur.se social.e qui aura une th\u00e9matique pr\u00e9-\u00e9tablie diff\u00e9rente \u00e0 chaque mois. Visiter le calendrier de programmation de la Maison Rose afin de connaitre la prochaine th\u00e9matique.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#groupe_discussion_thematique\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nMaison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc.<\/p>  \n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n<div style=\"margin-top: 30px;\">\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n\n<p>N\u2019h\u00e9sitez pas \u00e0 nous \u00e9crire ou \u00e0 nous appeler \u2014 nous sommes l\u00e0 pour vous accompagner, avec bienveillance et confidentialit\u00e9.<\/p>\n<p><strong>T\u00e9l\u00e9phone :<\/strong> 514 871-1717<br>\n<strong>Sans frais :<\/strong> 1 877 990-7171\u2028<br>\ninfo@rubanrose.org<br>\n<\/div>\n<\/div><\/div><fieldset id=\"field_28_116\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_116'><div class='gchoice gchoice_28_116_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_116_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_1' id='label_28_116_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.2' type='checkbox'  value='Conseil g\u00e9n\u00e9tique'  id='choice_28_116_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_2' id='label_28_116_2' class='gform-field-label gform-field-label--type-inline'>Conseil g\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.3' type='checkbox'  value='S\u00e9ances de yoga en studio'  id='choice_28_116_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_3' id='label_28_116_3' class='gform-field-label gform-field-label--type-inline'>S\u00e9ances de yoga en studio<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.4' type='checkbox'  value='S\u00e9ances de yoga en ligne'  id='choice_28_116_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_4' id='label_28_116_4' class='gform-field-label gform-field-label--type-inline'>S\u00e9ances de yoga en ligne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.5' type='checkbox'  value='Sophrologie'  id='choice_28_116_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_5' id='label_28_116_5' class='gform-field-label gform-field-label--type-inline'>Sophrologie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.6' type='checkbox'  value='Hypnose'  id='choice_28_116_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_6' id='label_28_116_6' class='gform-field-label gform-field-label--type-inline'>Hypnose<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.7' type='checkbox'  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(\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.11' type='checkbox'  value='Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)'  id='choice_28_116_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_11' id='label_28_116_11' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_116_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.12' type='checkbox'  value='Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)'  id='choice_28_116_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_116_12' id='label_28_116_12' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_116_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_111\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><div id=\"field_28_120\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div class=\"dyn-form-container-principal-accordion\">\n\n <p style=\"margin-bottom: 10px; color:#280062;font-weight:600;\">\nVous \u00eates admissibles aux services suivants :\n <\/p>  \n\n<div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">\nLigne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\n  Soutien psychosocial\n<\/button>\n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant\u00b7e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nConseil g\u00e9n\u00e9tique\u2028\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nSophrologie\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une approche douce et guid\u00e9e combinant respiration, relaxation et pleine conscience, con\u00e7ue pour am\u00e9liorer le bien-\u00eatre physique et \u00e9motionnel. Reconnue comme soin de support en oncologie, elle favorise la s\u00e9r\u00e9nit\u00e9.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/sophrologie\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nHypnose\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une approche de relaxation profonde et de visualisation guid\u00e9e qui aide \u00e0 apaiser l\u2019anxi\u00e9t\u00e9, \u00e0 soutenir l\u2019adaptation \u00e9motionnelle et \u00e0 retrouver un sentiment de calme int\u00e9rieur. Cette activit\u00e9 s\u2019adresse exclusivement aux personnes terminant leurs traitements ou en r\u00e9mission d\u2019un cancer du sein, afin de les accompagner avec bienveillance dans cette p\u00e9riode de transition et de r\u00e9\u00e9quilibre.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/hypnose\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nClinique Virtuelle\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Accessible 24\/7, cette plateforme vous permet de consulter gratuitement des m\u00e9decins, infirmier.\u00e8re.s et autres professionnel.le.s de la sant\u00e9 \u00e0 distance, en quelques clics, \u00e0 partir de votre t\u00e9l\u00e9phone, tablette ou ordinateur.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-medical\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Rencontres anim\u00e9es par un.e travailleur.se social.e sans th\u00e9matiques \u00e9tablies, destin\u00e9es aux personnes ayant re\u00e7u un diagnostic de cancer du sein. Un espace s\u00e9curitaire et confidentiel pour partager, \u00e9changer et briser l\u2019isolement.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#cafe_causerie\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nGroupe de discussion mensuel avec th\u00e9matique <span style=\"color:red;\">(\u00c0 VENIR)<\/span>\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un groupe anim\u00e9 par un.e travailleur.se social.e qui aura une th\u00e9matique pr\u00e9-\u00e9tablie diff\u00e9rente \u00e0 chaque mois. Visiter le calendrier de programmation de la Maison Rose afin de connaitre la prochaine th\u00e9matique.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#groupe_discussion_thematique\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\"\n  onclick=\"this.classList.toggle('active');\">\nMaison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc.<\/p>  \n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n<div style=\"margin-top: 30px;\">\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n\n<p>N\u2019h\u00e9sitez pas \u00e0 nous \u00e9crire ou \u00e0 nous appeler \u2014 nous sommes l\u00e0 pour vous accompagner, avec bienveillance et confidentialit\u00e9.<\/p>\n<p><strong>T\u00e9l\u00e9phone :<\/strong> 514 871-1717<br>\n<strong>Sans frais :<\/strong> 1 877 990-7171\u2028<br>\ninfo@rubanrose.org<br>\n<\/div>\n<\/div><\/div><fieldset id=\"field_28_121\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_121'><div class='gchoice gchoice_28_121_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_121_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_1' id='label_28_121_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.2' type='checkbox'  value='Conseil g\u00e9n\u00e9tique'  id='choice_28_121_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_2' id='label_28_121_2' class='gform-field-label gform-field-label--type-inline'>Conseil g\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.3' type='checkbox'  value='Sophrologie'  id='choice_28_121_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_3' id='label_28_121_3' class='gform-field-label gform-field-label--type-inline'>Sophrologie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.4' type='checkbox'  value='Hypnose'  id='choice_28_121_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_4' id='label_28_121_4' class='gform-field-label gform-field-label--type-inline'>Hypnose<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.5' type='checkbox'  value='Clinique virtuelle'  id='choice_28_121_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_5' id='label_28_121_5' class='gform-field-label gform-field-label--type-inline'>Clinique virtuelle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.6' type='checkbox'  value='Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)'  id='choice_28_121_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_6' id='label_28_121_6' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_121_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.7' type='checkbox'  value='Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)'  id='choice_28_121_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_121_7' id='label_28_121_7' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_121_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_122\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><div id=\"field_28_123\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div class=\"dyn-form-container-principal-accordion\">\n\n <p style=\"margin-bottom: 10px; color:#280062;font-weight:600;\">\nVous \u00eates admissibles aux services suivants :\n<\/p>\n\n <div style=\"margin-bottom: 10px;\"><button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle\u2028<\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n\n    <\/div>\n  <\/div>\n\n<div style=\"margin-bottom: 10px;\"><button class=\"dyn-form-accordion-button\" type=\"button\"\nonclick=\"this.classList.toggle('active');\">Soutien psychosocial<\/button> \n    <div class=\"dyn-form-container-description-accordion\">\n<p>Acc\u00e9dez \u00e0 un service gratuit et confidentiel offert par un.e travailleur.se social.e sp\u00e9cialis\u00e9.e. Ce service vise \u00e0 vous accompagner dans les d\u00e9fis \u00e9motionnels, relationnels et pratiques li\u00e9s \u00e0 votre r\u00f4le de proche aidant\u00b7e. Que vous ayez besoin de mieux comprendre la maladie, d\u2019exprimer ce que vous vivez ou de pr\u00e9server votre \u00e9quilibre, nous sommes l\u00e0 pour vous.<\/p>\n\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<div style=\"margin-bottom: 10px;\"><button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">Conseil g\u00e9n\u00e9tique\u2028<\/button> \n<div class=\"dyn-form-container-description-accordion\">\n<p>Le service de conseil g\u00e9n\u00e9tique est accessible pour vous accompagner dans la compr\u00e9hension des facteurs g\u00e9n\u00e9tiques en lien avec le cancer du sein. Ce service permet d\u2019\u00e9valuer les ant\u00e9c\u00e9dents personnels et\/ou familiaux de cancer et de vous aider \u00e0 faire des choix \u00e9clair\u00e9s pour votre sant\u00e9 et celle de vos proches.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/conseil-genetique\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">\nHypnose\n    <\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Une m\u00e9thode de relaxation profonde et de visualisation guid\u00e9e visant \u00e0 apaiser l\u2019anxi\u00e9t\u00e9, soutenir l\u2019adaptation \u00e9motionnelle et renforcer le sentiment de calme int\u00e9rieur. Offerte dans un cadre bienveillant et personnalis\u00e9.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/mieux-etre\/hypnose\/\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n<div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">Groupe de discussion \u00ab Caf\u00e9-causerie \u00bb <span style=\"color:red;\">(\u00c0 VENIR)<\/span><\/button> \n<div class=\"dyn-form-container-description-accordion\">\n<p>Rencontres anim\u00e9es par un.e travailleur.se social.e sans th\u00e9matiques \u00e9tablies, destin\u00e9es aux personnes ayant re\u00e7u un diagnostic de cancer du sein. Un espace s\u00e9curitaire et confidentiel pour partager, \u00e9changer et briser l\u2019isolement.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#cafe_causerie\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">Groupe de discussion mensuel avec th\u00e9matique <span style=\"color:red;\">(\u00c0 VENIR)<\/span><\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Un groupe anim\u00e9 par un.e travailleur.se social.e qui aura une th\u00e9matique pr\u00e9-\u00e9tablie diff\u00e9rente \u00e0 chaque mois. Visiter le calendrier de programmation de la Maison Rose afin de connaitre la prochaine th\u00e9matique.<\/p>\n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/services-et-ressources-de-soutien-par-les-pairs\/#groupe_discussion_thematique\" target=\"_blank\" rel=\"noopener\">En savoir plus<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n\n  <div style=\"margin-bottom: 10px;\">\n<button class=\"dyn-form-accordion-button\" type=\"button\" onclick=\"this.classList.toggle('active');\">Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al\u2028<\/button>\n<div class=\"dyn-form-container-description-accordion\">\n<p>Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc.<\/p>  \n<div style=\"margin-top: 20px!important;\"><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a><\/div>\n\n    <\/div>\n  <\/div>\n\n<\/div>\n<div style=\"margin-top: 30px;\">\n<p>N&#8217;oubliez-pas de vous abonner \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/infolettre\/\">notre infolettre<\/a> pour rester au courant de nos activit\u00e9s \u00e0 venir!<\/p>\n\n<p>N\u2019h\u00e9sitez pas \u00e0 nous \u00e9crire ou \u00e0 nous appeler \u2014 nous sommes l\u00e0 pour vous accompagner, avec bienveillance et confidentialit\u00e9.<\/p>\n<p><strong>T\u00e9l\u00e9phone :<\/strong> 514 871-1717<br>\n<strong>Sans frais :<\/strong> 1 877 990-7171\u2028<br>\ninfo@rubanrose.org<br>\n<\/div>\n<\/div><\/div><fieldset id=\"field_28_124\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\"  data-field-class=\"gfield--checkbox gfield--checkbox gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez cocher les services pour lesquels vous souhaitez vous inscrire :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_28_124'><div class='gchoice gchoice_28_124_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.1' type='checkbox'  value='Soutien psychosocial'  id='choice_28_124_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_124_1' id='label_28_124_1' class='gform-field-label gform-field-label--type-inline'>Soutien psychosocial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_124_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.2' type='checkbox'  value='Conseil g\u00e9n\u00e9tique'  id='choice_28_124_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_124_2' id='label_28_124_2' class='gform-field-label gform-field-label--type-inline'>Conseil g\u00e9n\u00e9tique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_124_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.3' type='checkbox'  value='Hypnose'  id='choice_28_124_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_124_3' id='label_28_124_3' class='gform-field-label gform-field-label--type-inline'>Hypnose<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_124_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.4' type='checkbox'  value='Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)'  id='choice_28_124_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_124_4' id='label_28_124_4' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion \u00ab\u00a0Caf\u00e9-causerie \u00bb (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_124_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.5' type='checkbox'  value='Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)'  id='choice_28_124_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_124_5' id='label_28_124_5' class='gform-field-label gform-field-label--type-inline'>Groupe de discussion mensuel avec th\u00e9matique (\u00c0 VENIR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_124_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_28_125\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p><strong>Autres services offerts sans inscription :<\/strong><\/p>\n<ul>\n\n<li><strong>Maison Rose \u2013 Espace de r\u00e9pit et d\u2019apprentissage \u00e0 Montr\u00e9al :<\/strong> Si vous \u00eates dans la r\u00e9gion de Montr\u00e9al, nous vous invitons \u00e0 d\u00e9couvrir notre Maison Rose, un lieu chaleureux et accueillant o\u00f9 sont offerts des ateliers et conf\u00e9rences gratuits sur divers sujets li\u00e9s au cancer du sein : proche aidance, avanc\u00e9es m\u00e9dicales, mieux-\u00eatre, retour au travail, etc. \n<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/maison-rose\/\" target=\"_blank\" rel=\"noopener\">Consultez notre programmation<\/a>.<\/li>\n\n<li><strong>Ligne Rose \u2013 Ligne d\u2019\u00e9coute confidentielle :\u2028<\/strong>\n<p>La ligne Rose est un service d\u2019\u00e9coute, offert en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation. <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-par-les-paires\/ligne-decoute-par-les-paires-aidantes\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus<\/a>.<\/p>\n<p>1-855-561-ROSE (7673)\u2028<br>           \nDu lundi au vendredi, de 9 h \u00e0 17 h<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><fieldset id=\"field_28_136\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--address gfield--address gfield--has-multiple-inputs\"  data-field-class=\"gfield--address gfield--address gfield--has-multiple-inputs\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veuillez entrer votre code postal<\/legend>    \n                    <div class='ginput_complex ginput_container has_zip ginput_container_address gform-grid-row' id='input_28_136' >\n                        <input type='hidden' class='gform_hidden' name='input_136.4' id='input_28_136_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_28_136_5_container' >\n                                    <input type='text' name='input_136.5' id='input_28_136_5' value=''    aria-required='false'    \/>\n                                    <label for='input_28_136_5' id='input_28_136_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_136.6' id='input_28_136_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_28_69\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--select gfield--select\"  data-field-class=\"gfield--select gfield--select\" ><label class='gfield_label gform-field-label' for='input_28_69'>Pour les cours de yoga en pr\u00e9sentiel, merci d\u2019indiquer le lieu ainsi que la\/le professeur.e qui vous conviendraient<\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_28_69' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>S\u00e9lectionnez un studio<\/option><option value='Myriam Coutu - Rimouski' >Myriam Coutu &#8211; Rimouski<\/option><option value='Lise Thibeault - Saint-Luc-de-Vincennes' >Lise Thibeault &#8211; Saint-Luc-de-Vincennes<\/option><option value='Laura Hernandez - Maison Rose, Montr\u00e9al' >Laura Hernandez &#8211; Maison Rose, Montr\u00e9al<\/option><option value='Laura Hernandez - Lac-Brome' >Laura Hernandez &#8211; Lac-Brome<\/option><option value='Mich\u00e8le Langlois - Sherbrooke' >Mich\u00e8le Langlois &#8211; Sherbrooke<\/option><option value='Sylvie Bilodeau - Lac-M\u00e9gantic' >Sylvie Bilodeau &#8211; Lac-M\u00e9gantic<\/option><option value='Marjolaine B\u00e9lair - Val-David' >Marjolaine B\u00e9lair &#8211; Val-David<\/option><option value='Ingrid Boursiquot - Anjou, Montr\u00e9al' >Ingrid Boursiquot &#8211; Anjou, Montr\u00e9al<\/option><option value='Ingrid Boursiquot - Rosemont, Montr\u00e9al' >Ingrid Boursiquot &#8211; Rosemont, Montr\u00e9al<\/option><option value='Line Lamontagne - Trois-Rivi\u00e8res' >Line Lamontagne &#8211; Trois-Rivi\u00e8res<\/option><\/select><\/div><\/div><div id=\"field_28_79\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--select gfield--select\"  data-field-class=\"gfield--select gfield--select\" ><label class='gfield_label gform-field-label' for='input_28_79'>Pour les cours de yoga en ligne, merci de pr\u00e9ciser la\/le professeur.e de votre choix<\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_28_79' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>S\u00e9lectionnez un.e professeur.e<\/option><option value='Lise Thibeault Yoga' >Lise Thibeault Yoga<\/option><option value='Laura Hernandez, Yoga &amp; Mouvement' >Laura Hernandez, Yoga &amp; Mouvement<\/option><option value='Carole Landry, Studio Vida Yoga' >Carole Landry, Studio Vida Yoga<\/option><option value='Suzanne Beaudoin' >Suzanne Beaudoin<\/option><\/select><\/div><\/div><fieldset id=\"field_28_172\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_172'>\n\t\t\t<div class='gchoice gchoice_28_172_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_172' type='radio' value='Oui'  id='choice_28_172_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_172_0' id='label_28_172_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_172_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_172' type='radio' value='Non'  id='choice_28_172_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_172_1' id='label_28_172_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_173\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_173'>\n\t\t\t<div class='gchoice gchoice_28_173_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_173' type='radio' value='Oui'  id='choice_28_173_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_173_0' id='label_28_173_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_173_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_173' type='radio' value='Non'  id='choice_28_173_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_173_1' id='label_28_173_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_174\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_174'>\n\t\t\t<div class='gchoice gchoice_28_174_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_174' type='radio' value='Oui'  id='choice_28_174_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_174_0' id='label_28_174_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_174_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_174' type='radio' value='Non'  id='choice_28_174_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_174_1' id='label_28_174_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_175\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_175'>\n\t\t\t<div class='gchoice gchoice_28_175_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='Oui'  id='choice_28_175_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_175_0' id='label_28_175_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_175_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='Non'  id='choice_28_175_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_175_1' id='label_28_175_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_176\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_176'>\n\t\t\t<div class='gchoice gchoice_28_176_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Oui'  id='choice_28_176_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_176_0' id='label_28_176_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_176_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Non'  id='choice_28_176_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_176_1' id='label_28_176_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_169\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<div>\n<p style=\"font-weight:700px;\">Vous semblez \u00eatre admissible aux services cit\u00e9s plus haut mais vous avez choisi de ne pas soumettre de demande pour le moment.<\/p>  \n\n<p>En attendant, nous vous invitons \u00e0 <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/\">en apprendre plus sur les services que nous offrons.<\/a>  \n<\/p>  \n<\/div> \n\n<div style=\"margin-top:20px;\">\n <a class=\"eventButton\" href=\"#field_28_5\">Remplir une demande d&#8217;aide financi\u00e8re<\/a>\n<\/div>\n\n<\/div><\/div><div id=\"field_28_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--section gfield--section\"  data-field-class=\"gfield--section gfield--section\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Valider mon admissibilit\u00e9 \u00e0 l&#039;aide financi\u00e8re<\/h3><\/div><fieldset id=\"field_28_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >\u00c0 quel stade \u00e9tait votre cancer du sein lors de votre dernier diagnostic?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_34'>\n\t\t\t<div class='gchoice gchoice_28_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Stade 0'  id='choice_28_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_0' id='label_28_34_0' class='gform-field-label gform-field-label--type-inline'>Stade 0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Stade 1'  id='choice_28_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_1' id='label_28_34_1' class='gform-field-label gform-field-label--type-inline'>Stade 1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Stade 2'  id='choice_28_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_2' id='label_28_34_2' class='gform-field-label gform-field-label--type-inline'>Stade 2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_34_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Stade 3'  id='choice_28_34_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_3' id='label_28_34_3' class='gform-field-label gform-field-label--type-inline'>Stade 3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_34_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Stade 4'  id='choice_28_34_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_4' id='label_28_34_4' class='gform-field-label gform-field-label--type-inline'>Stade 4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_34_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Je ne sais pas'  id='choice_28_34_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_34_5' id='label_28_34_5' class='gform-field-label gform-field-label--type-inline'>Je ne sais pas<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_171\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Veuillez indiquer la situation qui refl\u00e8te le mieux votre parcours et vos traitements pour le cancer du sein<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_171'>\n\t\t\t<div class='gchoice gchoice_28_171_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='Je suis actuellement en traitement pour le cancer du sein ou j\u2019ai termin\u00e9 mes traitements (chimioth\u00e9rapie, radioth\u00e9rapie, immunoth\u00e9rapie ou th\u00e9rapie cibl\u00e9e) depuis moins d\u2019un an'  id='choice_28_171_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_0' id='label_28_171_0' class='gform-field-label gform-field-label--type-inline'>Je suis actuellement en traitement pour le cancer du sein ou j\u2019ai termin\u00e9 mes traitements (chimioth\u00e9rapie, radioth\u00e9rapie, immunoth\u00e9rapie ou th\u00e9rapie cibl\u00e9e) depuis moins d\u2019un an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_171_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='J\u2019ai termin\u00e9 mes traitements (chimioth\u00e9rapie, radioth\u00e9rapie, immunoth\u00e9rapie ou th\u00e9rapie cibl\u00e9e) depuis plus d\u2019un an'  id='choice_28_171_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_1' id='label_28_171_1' class='gform-field-label gform-field-label--type-inline'>J\u2019ai termin\u00e9 mes traitements (chimioth\u00e9rapie, radioth\u00e9rapie, immunoth\u00e9rapie ou th\u00e9rapie cibl\u00e9e) depuis plus d\u2019un an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_171_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='Je suis sous hormonoth\u00e9rapie depuis moins d\u2019un an'  id='choice_28_171_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_2' id='label_28_171_2' class='gform-field-label gform-field-label--type-inline'>Je suis sous hormonoth\u00e9rapie depuis moins d\u2019un an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_171_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='Je suis sous hormonoth\u00e9rapie depuis plus d\u2019un an'  id='choice_28_171_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_3' id='label_28_171_3' class='gform-field-label gform-field-label--type-inline'>Je suis sous hormonoth\u00e9rapie depuis plus d\u2019un an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_171_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='Je suis en attente d\u2019une chirurgie (mastectomie, tumorectomie ou reconstruction mammaire) pour le cancer du sein ou j\u2019ai subi une chirurgie pour le cancer du sein depuis moins d\u2019un an'  id='choice_28_171_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_4' id='label_28_171_4' class='gform-field-label gform-field-label--type-inline'>Je suis en attente d\u2019une chirurgie (mastectomie, tumorectomie ou reconstruction mammaire) pour le cancer du sein ou j\u2019ai subi une chirurgie pour le cancer du sein depuis moins d\u2019un an<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_171_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='J\u2019ai subi une chirurgie (mastectomie, tumorectomie ou reconstruction mammaire) pour le cancer du sein depuis plus d\u2019un an'  id='choice_28_171_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_171_5' id='label_28_171_5' class='gform-field-label gform-field-label--type-inline'>J\u2019ai subi une chirurgie (mastectomie, tumorectomie ou reconstruction mammaire) pour le cancer du sein depuis plus d\u2019un an<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n\n<p>Vous ne semblez pas admissible \u00e0 notre service d\u2019aide financi\u00e8re. Nous vous invitons \u00e0 consulter les <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-financier\/\">crit\u00e8res d\u2019admissibilit\u00e9<\/a> pour en savoir davantage. Si votre situation venait \u00e0 changer, vous pourrez soumettre une nouvelle demande.<\/p>\n\n<p>Nous vous encourageons \u00e0 explorer nos diff\u00e9rents services de soutien. Vous pourriez \u00eatre admissible au <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\">soutien psychosocial<\/a> ou encore trouver d\u2019autres ressources utiles dans votre secteur gr\u00e2ce \u00e0 notre <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/autres-services\/repertoire-ressources\/\"> r\u00e9pertoire de ressources.<\/a><\/p>\n \n<p>Si vous souhaitez recevoir de l\u2019\u00e9coute, vous pouvez parler \u00e0 une personne de confiance gr\u00e2ce \u00e0 notre Ligne Rose. Cette ligne d\u2019\u00e9coute est offerte en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n \n<p>Appelez-nous au <strong>1-855-561-ROSE (7673)<\/strong><br>\nDu lundi au vendredi, de <strong>9 h \u00e0 17 h<\/strong><\/p>\n<\/div><\/div><fieldset id=\"field_28_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Vous vivez :<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_37'>\n\t\t\t<div class='gchoice gchoice_28_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Seul.e (c\u00e9libataire, veuf.ve, divorc\u00e9.e, s\u00e9par\u00e9.e)'  id='choice_28_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_37_0' id='label_28_37_0' class='gform-field-label gform-field-label--type-inline'>Seul.e (c\u00e9libataire, veuf.ve, divorc\u00e9.e, s\u00e9par\u00e9.e)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='En couple'  id='choice_28_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_37_1' id='label_28_37_1' class='gform-field-label gform-field-label--type-inline'>En couple<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Quelle est votre situation professionnelle\/source principale de revenus?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_93'>\n\t\t\t<div class='gchoice gchoice_28_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='En emploi'  id='choice_28_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_0' id='label_28_93_0' class='gform-field-label gform-field-label--type-inline'>En emploi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Travailleur.se autonome\/ind\u00e9pendant.e'  id='choice_28_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_1' id='label_28_93_1' class='gform-field-label gform-field-label--type-inline'>Travailleur.se autonome\/ind\u00e9pendant.e<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_93_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Sans emploi'  id='choice_28_93_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_2' id='label_28_93_2' class='gform-field-label gform-field-label--type-inline'>Sans emploi<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_93_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='En arr\u00eat maladie\/invalidit\u00e9'  id='choice_28_93_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_3' id='label_28_93_3' class='gform-field-label gform-field-label--type-inline'>En arr\u00eat maladie\/invalidit\u00e9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_93_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='\u00c0 l&#039;aide sociale'  id='choice_28_93_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_4' id='label_28_93_4' class='gform-field-label gform-field-label--type-inline'>\u00c0 l&#8217;aide sociale<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_93_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Retrait\u00e9.e'  id='choice_28_93_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_93_5' id='label_28_93_5' class='gform-field-label gform-field-label--type-inline'>Retrait\u00e9.e<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_39\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--number gfield--number\"  data-field-class=\"gfield--number gfield--number\" ><label class='gfield_label gform-field-label' for='input_28_39'>Votre nombre d\u2019enfants \u00e0 charge de 17 ans et moins<\/label><div class='ginput_container ginput_container_number'><input name='input_39' id='input_28_39' type='number' step='any' min='0' max='100' value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_28_39\" \/><div class='gfield_description instruction ' id='gfield_instruction_28_39'>Please enter a number from <strong>0<\/strong> to <strong>100<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_28_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Vos revenus bruts estim\u00e9s pour l\u2019ann\u00e9e en cours sont-ils inf\u00e9rieurs \u00e0 ?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_40'>\n\t\t\t<div class='gchoice gchoice_28_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Oui'  id='choice_28_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_40_0' id='label_28_40_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Non'  id='choice_28_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_40_1' id='label_28_40_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_186\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Vos revenus bruts estim\u00e9s pour l\u2019ann\u00e9e en cours sont-ils inf\u00e9rieurs \u00e0 ?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_186'>\n\t\t\t<div class='gchoice gchoice_28_186_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_186' type='radio' value='Oui'  id='choice_28_186_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_186_0' id='label_28_186_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_186_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_186' type='radio' value='Non'  id='choice_28_186_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_186_1' id='label_28_186_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n\n<p>Vous ne semblez pas admissible \u00e0 notre service d\u2019aide financi\u00e8re. Nous vous invitons \u00e0 consulter les <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-financier\/\">crit\u00e8res d\u2019admissibilit\u00e9<\/a> pour en savoir davantage. Si votre situation venait \u00e0 changer, vous pourrez soumettre une nouvelle demande.<\/p>\n\n<p>Nous vous encourageons \u00e0 explorer nos diff\u00e9rents services de soutien. Vous pourriez \u00eatre admissible au <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/services-de-soutien\/soutien-psychosocial\/\">soutien psychosocial<\/a> ou encore trouver d\u2019autres ressources utiles dans votre secteur gr\u00e2ce \u00e0 notre <a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/je-cherche\/autres-services\/repertoire-ressources\/\"> r\u00e9pertoire de ressources.<\/a><\/p>\n \n<p>Si vous souhaitez recevoir de l\u2019\u00e9coute, vous pouvez parler \u00e0 une personne de confiance gr\u00e2ce \u00e0 notre Ligne Rose. Cette ligne d\u2019\u00e9coute est offerte en toute confidentialit\u00e9 partout \u00e0 travers le Qu\u00e9bec. Nos pair.e.s aidant.e.s, form\u00e9.e.s et exp\u00e9riment\u00e9.e.s, sont l\u00e0 pour vous \u00e9couter, r\u00e9pondre \u00e0 vos questions, vous aider \u00e0 naviguer dans le syst\u00e8me de sant\u00e9 et vous orienter vers les ressources les plus adapt\u00e9es \u00e0 votre situation.<\/p>\n \n<p>Appelez-nous au <strong>1-855-561-ROSE (7673)<\/strong><br>\nDu lundi au vendredi, de <strong>9 h \u00e0 17 h<\/strong><\/p>\n<\/div><\/div><div id=\"field_28_42\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p>Vous semblez \u00eatre admissible \u00e0 l\u2019aide financi\u00e8re.\u00a0Pour poursuivre l\u2019inscription, vous devez avoir acc\u00e8s \u00e0 votre avis de cotisation provincial. D\u2019autres documents pourraient \u00e9galement vous \u00eatre exig\u00e9s.<\/p>\n <p>Une attestation m\u00e9dicale devra \u00eatre compl\u00e9t\u00e9 par un.e professionnel.le de la sant\u00e9 (m\u00e9decin traitant, infermier.\u00e8re, travailleur.se social.e, etc.).\u2028 Veuillez noter qu\u2019un d\u00e9lai minimal de 12 mois doit s\u00e9parer chaque demande accept\u00e9e.<\/p>\n<\/div><\/div><fieldset id=\"field_28_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Souhaitez-vous soumettre une demande?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_43'>\n\t\t\t<div class='gchoice gchoice_28_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Oui'  id='choice_28_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_43_0' id='label_28_43_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Non'  id='choice_28_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_43_1' id='label_28_43_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_185\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--radio gfield--radio\"  data-field-class=\"gfield--radio gfield--radio\" ><legend class='gfield_label gform-field-label' >Comment souhaitez-vous recevoir l\u2019aide financi\u00e8re?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_185'>\n\t\t\t<div class='gchoice gchoice_28_185_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_185' type='radio' value='Depot direct'  id='choice_28_185_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_185_0' id='label_28_185_0' class='gform-field-label gform-field-label--type-inline'>D\u00e9p\u00f4t direct<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_185_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_185' type='radio' value='Cartes-cadeaux'  id='choice_28_185_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_185_1' id='label_28_185_1' class='gform-field-label gform-field-label--type-inline'>Cartes-cadeaux (\u00e9piceries participantes)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div class=\"bordered-content-dyn-form\">\n<p style=\"font-weight:700px;\">Vous semblez \u00eatre admissible \u00e0 l&#8217;aide financi\u00e8re, mais vous avez choisi de ne pas soumettre de demande pour le moment.<\/p>  \n\n<p>En attendant, nous vous invitons \u00e0 consulter les autres services auxquels vous avez acc\u00e8s.<\/p>  \n\n\n\n<div style=\"margin-top: 20px!important; cursor:pointer!important;\">\n<a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/formulaire-dynamique-test\/\" target=\"_self\" rel=\"noopener\">Recommencer le formulaire<\/a>\n<\/div>\n\n\n<\/div><\/div><div id=\"field_28_179\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden gfield--section gfield--section\"  data-field-class=\"gfield--section gfield--section\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Section finale<\/h3><\/div><div id=\"field_28_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--text gfield--text\"  data-field-class=\"gfield--text gfield--text\" ><label class='gfield_label gform-field-label' for='input_28_16'>Pr\u00e9nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_28_16' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--text gfield--text\"  data-field-class=\"gfield--text gfield--text\" ><label class='gfield_label gform-field-label' for='input_28_15'>Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_28_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_51\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--email gfield--email\"  data-field-class=\"gfield--email gfield--email\" ><label class='gfield_label gform-field-label' for='input_28_51'>Adresse courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_51' id='input_28_51' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_28_50\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--date gfield--date\"  data-field-class=\"gfield--date gfield--date\" ><label class='gfield_label gform-field-label' for='input_28_50'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_50' id='input_28_50' type='text' value='--' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_28_50_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_28_50_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_28_50' class='gform_hidden' value='https:\/\/rubanrose.wpbeta.vortexdev.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_28_52\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--address gfield--address gfield--has-multiple-inputs\"  data-field-class=\"gfield--address gfield--address gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_28_52' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_28_52_1_container' >\n                                        <input type='text' name='input_52.1' id='input_28_52_1' value=''    aria-required='true'    \/>\n                                        <label for='input_28_52_1' id='input_28_52_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_28_52_2_container' >\n                                        <input type='text' name='input_52.2' id='input_28_52_2' value=''     aria-required='false'   \/>\n                                        <label for='input_28_52_2' id='input_28_52_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_28_52_3_container' >\n                                    <input type='text' name='input_52.3' id='input_28_52_3' value=''    aria-required='true'    \/>\n                                    <label for='input_28_52_3' id='input_28_52_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_28_52_4_container' >\n                                        <select name='input_52.4' id='input_28_52_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_28_52_4' id='input_28_52_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_28_52_5_container' >\n                                    <input type='text' name='input_52.5' id='input_28_52_5' value=''    aria-required='true'    \/>\n                                    <label for='input_28_52_5' id='input_28_52_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_52.6' id='input_28_52_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_28_53\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--phone gfield--phone\"  data-field-class=\"gfield--phone gfield--phone\" ><label class='gfield_label gform-field-label' for='input_28_53'>Num\u00e9ro de t\u00e9l\u00e9phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_53' id='input_28_53' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_182\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><p style=\"font-size:16px;color:#280062;font-weight:700!important;\">\nDocument pour l&#8217;aide financi\u00e8re\n<\/p><\/div><div id=\"field_28_180\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half boutonAFformulaireServices field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--fileupload gfield--fileupload gfield--fileupload-single\"  data-field-class=\"gfield--fileupload gfield--fileupload gfield--fileupload-single\" ><label class='gfield_label gform-field-label' for='input_28_180'>T\u00e9l\u00e9verser mes informations m\u00e9dicales<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='41943040' \/><input name='input_180' id='input_28_180' type='file' class='large' aria-describedby=\"gfield_upload_rules_28_180\" onchange='javascript:gformValidateFileSize( this, 41943040 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_28_180'>Max. file size: 40 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_28_180'><\/div> <\/div><\/div><div id=\"field_28_181\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--html gfield--html\"  data-field-class=\"gfield--html gfield--html\" ><div><a class=\"eventButton\" href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/wp-content\/uploads\/2025\/12\/Informations-medicales-Formulaire-unique.pdf\" target=\"_blank\" rel=\"noopener\">Document informations m\u00e9dicales<\/a><\/div><\/div><div id=\"field_28_183\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--fileupload gfield--fileupload gfield--fileupload-multiple\"  data-field-class=\"gfield--fileupload gfield--fileupload gfield--fileupload-multiple\" ><label class='gfield_label gform-field-label' for='gform_browse_button_28_183'>Avis de cotisation<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_28_183' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_28_183&quot;,&quot;container&quot;:&quot;gform_multifile_upload_28_183&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_28_183&quot;,&quot;filelist&quot;:&quot;gform_preview_28_183&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/rubanrose.wpbeta.vortexdev.com\\\/en\\\/?gf_page=ec680283a3876ce&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/rubanrose.wpbeta.vortexdev.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/rubanrose.wpbeta.vortexdev.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;41943040b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:28,&quot;field_id&quot;:183,&quot;_gform_file_upload_nonce_28_183&quot;:&quot;bee09d7a71&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_28_183&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_28_183' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_28_183' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_28_183\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_28_183'>Max. file size: 40 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_28_183'><\/ul> <div id='gform_preview_28_183' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_28_184\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half boutonAFformulaireServices field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--fileupload gfield--fileupload gfield--fileupload-single\"  data-field-class=\"gfield--fileupload gfield--fileupload gfield--fileupload-single\" ><label class='gfield_label gform-field-label' for='input_28_184'>Sp\u00e9cimen de ch\u00e8que<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='41943040' \/><input name='input_184' id='input_28_184' type='file' class='large' aria-describedby=\"gfield_upload_rules_28_184\" onchange='javascript:gformValidateFileSize( this, 41943040 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_28_184'>Max. file size: 40 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_28_184'><\/div> <\/div><\/div><fieldset id=\"field_28_59\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--consent gfield--consent gfield--has-multiple-inputs\"  data-field-class=\"gfield--consent gfield--consent gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >J\u2019atteste que les informations ci-dessus sont exactes et compl\u00e8tes. Les donn\u00e9es anonymis\u00e9es serviront \u00e0 des fins statistiques.  En guise de v\u00e9rification, j\u2019autorise la Fondation cancer du sein du Qu\u00e9bec \u00e0 discuter de mon dossier avec les membres de  mon \u00e9quipe m\u00e9dicale. Je comprends que la Fondation cancer du sein du Qu\u00e9bec se r\u00e9serve le droit de refuser toute demande pour un motif qu\u2019elle juge raisonnable, que les sommes vers\u00e9es en cas d&#039;une demande pour l&#039;aide financi\u00e8re devront respecter les limites du budget allou\u00e9 annuellement pour ce programme et que les montants octroy\u00e9s et les crit\u00e8res d\u2019admissibilit\u00e9 peuvent changer sans pr\u00e9avis.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_59.1' id='input_28_59_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_28_59_1' >J\u2019atteste que les informations ci-dessus sont exactes et compl\u00e8tes. Les donn\u00e9es anonymis\u00e9es serviront \u00e0 des fins statistiques.  En guise de v\u00e9rification, j\u2019autorise la Fondation cancer du sein du Qu\u00e9bec \u00e0 discuter de mon dossier avec les membres de  mon \u00e9quipe m\u00e9dicale. Je comprends que la Fondation cancer du sein du Qu\u00e9bec se r\u00e9serve le droit de refuser toute demande pour un motif qu\u2019elle juge raisonnable, que les sommes vers\u00e9es en cas d&#8217;une demande pour l&#8217;aide financi\u00e8re devront respecter les limites du budget allou\u00e9 annuellement pour ce programme et que les montants octroy\u00e9s et les crit\u00e8res d\u2019admissibilit\u00e9 peuvent changer sans pr\u00e9avis.<span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_59.2' value='J\u2019atteste que les informations ci-dessus sont exactes et compl\u00e8tes. Les donn\u00e9es anonymis\u00e9es serviront \u00e0 des fins statistiques.  En guise de v\u00e9rification, j\u2019autorise la Fondation cancer du sein du Qu\u00e9bec \u00e0 discuter de mon dossier avec les membres de  mon \u00e9quipe m\u00e9dicale. Je comprends que la Fondation cancer du sein du Qu\u00e9bec se r\u00e9serve le droit de refuser toute demande pour un motif qu\u2019elle juge raisonnable, que les sommes vers\u00e9es en cas d&#039;une demande pour l&#039;aide financi\u00e8re devront respecter les limites du budget allou\u00e9 annuellement pour ce programme et que les montants octroy\u00e9s et les crit\u00e8res d\u2019admissibilit\u00e9 peuvent changer sans pr\u00e9avis.' class='gform_hidden' \/><input type='hidden' name='input_59.3' value='22' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_28_68\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--consent gfield--consent gfield--has-multiple-inputs\"  data-field-class=\"gfield--consent gfield--consent gfield--has-multiple-inputs\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mention loi 25<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_28_68' tabindex='0'><br \/>\n<\/div><div class='ginput_container ginput_container_consent'><input name='input_68.1' id='input_28_68_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_28_68\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_28_68_1' >J\u2019accepte de recevoir des courriels de la part de la Fondation cancer du sein du Qu\u00e9bec.<a href=\"https:\/\/rubanrose.wpbeta.vortexdev.com\/politique-de-confidentialite\/\"> En savoir plus sur la Loi 25 et notre politique de confidentialit\u00e9.<\/a><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_68.2' value='J\u2019accepte de recevoir des courriels de la part de la Fondation cancer du sein du Qu\u00e9bec.&lt;a href=&quot;https:\/\/rubanrose.wpbeta.vortexdev.com\/politique-de-confidentialite\/&quot;&gt; En savoir plus sur la Loi 25 et notre politique de confidentialit\u00e9.&lt;\/a&gt;' class='gform_hidden' \/><input type='hidden' name='input_68.3' value='22' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_28' class='btn btn--fill-secondary gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Envoyer'  >Envoyer<\/button> <input type='hidden' name='gform_ajax' 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