{"id":5732,"date":"2025-04-11T14:20:00","date_gmt":"2025-04-11T19:20:00","guid":{"rendered":"https:\/\/periproxy.com\/portail-de-selection-proxy240813\/"},"modified":"2026-04-28T08:54:34","modified_gmt":"2026-04-28T13:54:34","slug":"screening-portal-proxy-t1d","status":"publish","type":"page","link":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/","title":{"rendered":"Screening Portal &#8211; proxy T1D"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5732\" class=\"elementor elementor-5732 elementor-5716\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2d3b2c9 elementor-section-height-min-height elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"2d3b2c9\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;1147ba5&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0014b6e\" data-id=\"0014b6e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-721c5cb elementor-widget elementor-widget-heading\" data-id=\"721c5cb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Screening Questionnaire<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9b9f0e4 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9b9f0e4\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;f188bea&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a41b1fe\" data-id=\"a41b1fe\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c5a08bf study_form_container elementor-widget elementor-widget-wp-widget-gform_widget\" data-id=\"c5a08bf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wp-widget-gform_widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"jupiterx-widget widget_gform_widget\"><div class=\"jupiterx-widget-content\"><script id=\"wp-dom-ready-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/dist\/dom-ready.min.js?ver=a06281ae5cf5500e9317\"><\/script>\n<script id=\"wp-hooks-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/dist\/hooks.min.js?ver=7496969728ca0f95732d\"><\/script>\n<script id=\"wp-i18n-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/dist\/i18n.min.js?ver=781d11515ad3d91786ec\"><\/script>\n<script id=\"wp-i18n-js-after\">\nwp.i18n.setLocaleData( { 'text direction\\u0004ltr': [ 'ltr' ] } );\n\/\/# sourceURL=wp-i18n-js-after\n<\/script>\n<script id=\"wp-a11y-js-translations\">\n( function( domain, translations ) {\n\tvar localeData = translations.locale_data[ domain ] || translations.locale_data.messages;\n\tlocaleData[\"\"].domain = domain;\n\twp.i18n.setLocaleData( localeData, domain );\n} )( \"default\", {\"translation-revision-date\":\"2026-05-14 16:37:59+0000\",\"generator\":\"GlotPress\\\/4.0.3\",\"domain\":\"messages\",\"locale_data\":{\"messages\":{\"\":{\"domain\":\"messages\",\"plural-forms\":\"nplurals=2; plural=n != 1;\",\"lang\":\"en_CA\"},\"Notifications\":[\"Notifications\"]}},\"comment\":{\"reference\":\"wp-includes\\\/js\\\/dist\\\/a11y.js\"}} );\n\/\/# sourceURL=wp-a11y-js-translations\n<\/script>\n<script id=\"wp-a11y-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/dist\/a11y.min.js?ver=af934e5259bc51b8718e\"><\/script>\n<script id=\"jquery-core-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/jquery\/jquery.min.js?ver=3.7.1\"><\/script>\n<script id=\"jquery-migrate-js\" src=\"https:\/\/periproxy.com\/wp-includes\/js\/jquery\/jquery-migrate.min.js?ver=3.4.1\"><\/script>\n<script id=\"gform_json-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/jquery.json.min.js?ver=2.10.2\"><\/script>\n<script id=\"gform_gravityforms-js-extra\">\nvar gf_global = {\"gf_currency_config\":{\"name\":\"Canadian Dollar\",\"symbol_left\":\"$\",\"symbol_right\":\"CAD\",\"symbol_padding\":\" \",\"thousand_separator\":\",\",\"decimal_separator\":\".\",\"decimals\":2,\"code\":\"CAD\"},\"base_url\":\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\",\"number_formats\":[],\"spinnerUrl\":\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg\",\"version_hash\":\"3534f892b5b7a731a553f7122ae755f0\",\"strings\":{\"newRowAdded\":\"New row added.\",\"rowRemoved\":\"Row removed\",\"formSaved\":\"The form has been saved.  The content contains the link to return and complete the form.\"}};\n\/\/# sourceURL=gform_gravityforms-js-extra\n<\/script>\n<script id=\"gform_gravityforms-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/gravityforms.min.js?ver=2.10.2\"><\/script>\n<script id=\"gform_page_conditional_logic-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/page_conditional_logic.min.js?ver=2.10.2\"><\/script>\n<script id=\"gform_conditional_logic-js-extra\">\nvar gf_legacy = {\"is_legacy\":\"\"};\n\/\/# sourceURL=gform_conditional_logic-js-extra\n<\/script>\n<script id=\"gform_conditional_logic-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/conditional_logic.min.js?ver=2.10.2\"><\/script>\n<script id=\"gform_masked_input-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/jquery.maskedinput.min.js?ver=2.10.2\"><\/script>\n<script id=\"gform_placeholder-js\" defer='defer' src=\"https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/js\/placeholders.jquery.min.js?ver=2.10.2\"><\/script>\n<script>\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<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework screening_form_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_148' style='display:none'><div id='gf_148' 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_148' id='gform_148' class='screening_form' action='\/en\/wp-json\/wp\/v2\/pages\/5732#gf_148' data-formid='148' novalidate><input id=partial_entry_id_148 class=\"partial_entry_id\" type=hidden name=\"partial_entry_id\" value=\"pending\" data-form_id=\"148\"\/><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfcVEokAAAAAGEsyVCmhFv4Q0tMXTKXOqoeR97w' data-tabindex='0'><input id=\"input_de2156052efb61d60eb0e936bc119b95\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_de2156052efb61d60eb0e936bc119b95\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_148_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_148' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_148_23\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_margin_top no_margin_bottom no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\n    document.addEventListener(\"DOMContentLoaded\", function () {\n    \n        jQuery(document).on(\"change\", \"input[name='input_1'], input[name='input_5'], input[name='input_7'], input[name='input_8'], input[name='input_9']\", function () {\n            let q1 = jQuery(\"input[name='input_1']:checked\").val();\n            let q5 = jQuery(\"input[name='input_5']:checked\").val();\n            let q7 = jQuery(\"input[name='input_7']:checked\").val();\n            let q8 = jQuery(\"input[name='input_8']:checked\").val();\n            let q9 = jQuery(\"input[name='input_9']:checked\").val();\n    \n            let eligible = 0; \/\/ Par d\u00e9faut, l'\u00e9ligibilit\u00e9 est 0\n    \n    \n    \n            \/\/ Verification de q1 : Groupe d'\u00e2ge\n            if (q1 !== undefined && (q1 === \"18-34\" || q1 === \"35-54\" || q1 === \"55-plus\")) {\n                eligible = 1; \/\/ Si q1 est vrai, on met \u00e9ligible \u00e0 1\n                \n                \/\/ V\u00e9rification de q5 : Pays\n                if (q5 === undefined) {\n                    jQuery(\"#input_148_22\").val(eligible).change();\n                    return;\n                }\n                if (q5 === \"canada\") {\n                    eligible = 1; \/\/ Si q5 est vrai, on met \u00e9ligible \u00e0 1\n    \n                    \/\/ V\u00e9rification de q7 : Clinical trial\n                    if (q7 === undefined) {\n                        jQuery(\"#input_148_22\").val(eligible).change();\n                        return;\n                    }\n                    if (q7 === \"No\") {\n                        eligible = 1; \/\/ Si q7 est vrai, on met \u00e9ligible \u00e0 1\n    \n                        \/\/ V\u00e9rification de q8 : Depuis combien de temps est-il atteint ?\n                        if (q8 === undefined) {\n                            jQuery(\"#input_148_22\").val(eligible).change();\n                            return;\n                        }\n                        if (q8 === \"moins-6-mois\" || q8 === \"6-mois-1-an\" || q8 === \"1-an-2-ans\") {\n                            eligible = 1; \/\/ Si q8 est vrai, on met \u00e9ligible \u00e0 1\n    \n                            if (q9 === undefined) {\n                                jQuery(\"#input_148_22\").val(eligible).change();\n                                return;\n                            }\n                            if (q9 === \"parent\" || q9 === \"grand-parent\" || q9 === \"tuteur-legal\") {\n                                eligible = 1; \/\/ Si q9 est vrai, on met \u00e9ligible \u00e0 1\n                            }\n                            else {\n                                eligible = 0;\n                                jQuery(\"#input_148_22\").val(eligible).change();\n                                return;\n                            }\n    \n                        }\n                        else {\n                            eligible = 0;\n                            jQuery(\"#input_148_22\").val(eligible).change();\n                            return;\n                        }\n    \n                    }\n                    else {\n                        eligible = 0;\n                        jQuery(\"#input_148_22\").val(eligible).change();\n                        return;\n                    }\n    \n                }\n                else {\n                    eligible = 0;\n                    jQuery(\"#input_148_22\").val(eligible).change();\n                    return;\n                }\n    \n            }\n            else {\n                eligible = 0;\n                jQuery(\"#input_148_22\").val(eligible).change();\n                return;\n            }\n        });\n        jQuery(\"#input_148_22\").val(eligible).change();\n    });\n    <\/script>\n    <\/div><div id=\"field_148_22\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_22' id='input_148_22' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/div><div id=\"field_148_30\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_margin_top no_margin_bottom no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\n\ndocument.addEventListener(\"DOMContentLoaded\", function () {\n    jQuery(document).on(\"change\", \"input[name='input_1'], input[name='input_5'], input[name='input_7'], input[name='input_8'], input[name='input_9']\", function () {\n        setTimeout(function () {\n            function getLabelText(inputName) {\n                let selected = jQuery(\"input[name='\" + inputName + \"']:checked\");\n                if (selected.length > 0) {\n                    \/\/ Cherche le label associ\u00e9 \u00e0 l'input s\u00e9lectionn\u00e9\n                    let label = jQuery(\"label[for='\" + selected.attr(\"id\") + \"']\");\n                    return label.text().trim();\n                }\n                return null;\n            }\n\n            let exclusionReasons = [];\n\n            let q1 = jQuery(\"input[name='input_1']:checked\").val();\n            if (q1 === \"moins-18\") {\n                let label = getLabelText(\"input_1\");\n                if (label) exclusionReasons.push(label);\n            }\n\nlet q5 = jQuery(\"input[name='input_5']:checked\").val();\n            if (q5 === \"etats-unis\" || q5 === \"autre\") {\n                let label = getLabelText(\"input_5\");\n                if (label) exclusionReasons.push(label);\n            }\n\n            let q7 = jQuery(\"input[name='input_7']:checked\").val();\n            if (q7 === \"Yes\") {\n                let label = getLabelText(\"input_7\");\n                if (label) exclusionReasons.push(label);\n            }\n\n            let q8 = jQuery(\"input[name='input_8']:checked\").val();\n            if (\n                q8 === \"2-3-ans\" ||\n                q8 === \"plus-3-ans\"\n            ) {\n                let label = getLabelText(\"input_8\");\n                if (label) exclusionReasons.push(label);\n            }\n\n            let q9 = jQuery(\"input[name='input_9']:checked\").val();\n            if (q9 === \"voisin\" || q9 === \"autre\") {\n                let label = getLabelText(\"input_9\");\n                if (label) exclusionReasons.push(label);\n            }\n\n           if (exclusionReasons.length > 0) {\n                jQuery(\"#input_148_31\").val(exclusionReasons.join(\", \")).change();\n            } else {\n                jQuery(\"#input_148_31\").val(\"\").change();\n            }\n        }, 50); \/\/ Laisse le temps \u00e0 Gravity Forms d'enregistrer la s\u00e9lection\n    });\n});\n<\/script>\n<\/div><div id=\"field_148_31\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_31' id='input_148_31' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><fieldset id=\"field_148_28\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_28.1' id='input_148_28_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_148_28_1' >By checking this box, I accept the site\u2019s privacy policy<\/label><input type='hidden' name='input_28.2' value='By checking this box, I accept the site\u2019s privacy policy' class='gform_hidden' \/><input type='hidden' name='input_28.3' value='17' class='gform_hidden' \/><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_148_29' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_2' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_148_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your age group?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_148_1'>\n\t\t\t<div class='gchoice gchoice_148_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='moins-18'  id='choice_148_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_1_0' id='label_148_1_0' class='gform-field-label gform-field-label--type-inline'>Under 18<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='18-34'  id='choice_148_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_1_1' id='label_148_1_1' class='gform-field-label gform-field-label--type-inline'>18 to 34<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='35-54'  id='choice_148_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_1_2' id='label_148_1_2' class='gform-field-label gform-field-label--type-inline'>35 to 54<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_1_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='55-plus'  id='choice_148_1_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_1_3' id='label_148_1_3' class='gform-field-label gform-field-label--type-inline'>55 or older<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_2' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_3' class='gform_page' data-js='page-field-id-2' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_148_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >In what country do you live?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_148_5'>\n\t\t\t<div class='gchoice gchoice_148_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='canada'  id='choice_148_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_5_0' id='label_148_5_0' class='gform-field-label gform-field-label--type-inline'>Canada<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='etats-unis'  id='choice_148_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_5_1' id='label_148_5_1' class='gform-field-label gform-field-label--type-inline'>United States<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='autre'  id='choice_148_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_5_2' id='label_148_5_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_4' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_148_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is your child currently participating in a clinical trial for T1D ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_148_7'>\n\t\t\t<div class='gchoice gchoice_148_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_148_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_7_0' id='label_148_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_148_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_7_1' id='label_148_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_6' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_5' class='gform_page' data-js='page-field-id-6' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_148_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How long has the child had Type 1 Diabetes?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_148_8'>\n\t\t\t<div class='gchoice gchoice_148_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='moins-6-mois'  id='choice_148_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_8_0' id='label_148_8_0' class='gform-field-label gform-field-label--type-inline'>Less than 6 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='6-mois-1-an'  id='choice_148_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_8_1' id='label_148_8_1' class='gform-field-label gform-field-label--type-inline'>Between 6 months and 1 year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1-an-2-ans'  id='choice_148_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_8_2' id='label_148_8_2' class='gform-field-label gform-field-label--type-inline'>Between 1 year and 2 years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2-3-ans'  id='choice_148_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_8_3' id='label_148_8_3' class='gform-field-label gform-field-label--type-inline'>Between 2 years and 3 years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='plus-3-ans'  id='choice_148_8_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_8_4' id='label_148_8_4' class='gform-field-label gform-field-label--type-inline'>More than 3 years<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_27' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_27' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_6' class='gform_page' data-js='page-field-id-27' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_148_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your relationship with the child?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_148_9'>\n\t\t\t<div class='gchoice gchoice_148_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='parent'  id='choice_148_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_9_0' id='label_148_9_0' class='gform-field-label gform-field-label--type-inline'>Parent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='tuteur-legal'  id='choice_148_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_9_1' id='label_148_9_1' class='gform-field-label gform-field-label--type-inline'>Legal guardian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='grand-parent'  id='choice_148_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_9_2' id='label_148_9_2' class='gform-field-label gform-field-label--type-inline'>Grandparent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='voisin'  id='choice_148_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_9_3' id='label_148_9_3' class='gform-field-label gform-field-label--type-inline'>Neighbour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_148_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='autre'  id='choice_148_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_148_9_4' id='label_148_9_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_10' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_10' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_7' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_148_24\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Good news! You are eligible to participate in our study.\n\nPlease fill in the fields below to create your account and gain access to the study questionnaires.\n\n<b>An email with instructions on how to access the study will be sent to you.<\/b> Don\u2019t forget to check your spam or junk folder!<\/div><div id=\"field_148_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_148_11'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_148_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_148_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_148_12'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_148_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_148_15\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full no_margin_top no_number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_148_15'>Email<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_15' id='input_148_15' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_148_32\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full no_margin_top no_number field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_148_32'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_32' id='input_148_32' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_148_25\" class=\"gfield gfield--type-password gfield--input-type-password gfield--width-full no_margin_top legend-standard no_number field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Password<\/legend><div class='ginput_complex ginput_container ginput_container_password gform-grid-row' id='input_148_25_container'>\n\t\t\t\t\t\t<span id='input_148_25_1_container' class='ginput_password ginput_left gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_25' id='input_148_25'    value=''    aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_148_25' class='gform-field-label gform-field-label--type-sub '>Enter Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_148_25_2_container' class='ginput_password ginput_right gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_25_2' id='input_148_25_2'   value=''    aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_148_25_2' class='gform-field-label gform-field-label--type-sub '>Confirm Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_148_33' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_148_33' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_148_8' class='gform_page' data-js='page-field-id-33' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_148_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_148_3\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full no_number gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Thank you for your interest in participating in our study. After reviewing your responses, we note that you unfortunately do not meet the eligibility criteria for this study. <\/p>\n<p>We thank you for your time and participation.<\/p><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_148' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='submit' id='gform_submit_button_148' class='gform_button button gform-button--width-full' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=148&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;hash=b4415b335f0eb50efbb2ddde2f0857f6' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_148' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_148' id='gform_theme_148' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_148' id='gform_style_settings_148' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_148' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='148' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='tlRFD2GaQVGLrOGRMsN+FUYf44o1MwWGOKQ+yGFHBFy2BGm52kX7aqEjNJgJvPgMEtuGo+dOW7hVqFcZZdg8g8IBfe6jhNrGfEXnDC5SgDWDtXk=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_148' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_148' id='gform_target_page_number_148' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_148' id='gform_source_page_number_148' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_148' id='gform_ajax_frame_148' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 148, 'https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_148').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_148');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_148').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_148').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_148').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_148').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_148').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_148').val();gformInitSpinner( 148, 'https:\/\/periproxy.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [148, current_page]);window['gf_submitting_148'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_148').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_148').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [148]);window['gf_submitting_148'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_148').text());}else{jQuery('#gform_148').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"148\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_148\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_148\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_148\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 148, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Screening Questionnaire<\/p>\n","protected":false},"author":546,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5732","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Screening Portal - proxy T1D - R\u00e9seau PROxy<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Screening Portal - proxy T1D - R\u00e9seau PROxy\" \/>\n<meta property=\"og:description\" content=\"Screening Questionnaire\" \/>\n<meta property=\"og:url\" content=\"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/\" \/>\n<meta property=\"og:site_name\" content=\"R\u00e9seau PROxy\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-28T13:54:34+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/periproxy.com\\\/en\\\/screening-portal-proxy-t1d\\\/\",\"url\":\"https:\\\/\\\/periproxy.com\\\/en\\\/screening-portal-proxy-t1d\\\/\",\"name\":\"Screening Portal - proxy T1D - R\u00e9seau PROxy\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/periproxy.com\\\/#website\"},\"datePublished\":\"2025-04-11T19:20:00+00:00\",\"dateModified\":\"2026-04-28T13:54:34+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/periproxy.com\\\/en\\\/screening-portal-proxy-t1d\\\/#breadcrumb\"},\"inLanguage\":\"en-CA\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/periproxy.com\\\/en\\\/screening-portal-proxy-t1d\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/periproxy.com\\\/en\\\/screening-portal-proxy-t1d\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\\\/\\\/periproxy.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Screening Portal &#8211; proxy T1D\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/periproxy.com\\\/#website\",\"url\":\"https:\\\/\\\/periproxy.com\\\/\",\"name\":\"R\u00e9seau PROxy\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/periproxy.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-CA\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Screening Portal - proxy T1D - R\u00e9seau PROxy","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/","og_locale":"en_US","og_type":"article","og_title":"Screening Portal - proxy T1D - R\u00e9seau PROxy","og_description":"Screening Questionnaire","og_url":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/","og_site_name":"R\u00e9seau PROxy","article_modified_time":"2026-04-28T13:54:34+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/","url":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/","name":"Screening Portal - proxy T1D - R\u00e9seau PROxy","isPartOf":{"@id":"https:\/\/periproxy.com\/#website"},"datePublished":"2025-04-11T19:20:00+00:00","dateModified":"2026-04-28T13:54:34+00:00","breadcrumb":{"@id":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/#breadcrumb"},"inLanguage":"en-CA","potentialAction":[{"@type":"ReadAction","target":["https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/periproxy.com\/en\/screening-portal-proxy-t1d\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"https:\/\/periproxy.com\/"},{"@type":"ListItem","position":2,"name":"Screening Portal &#8211; proxy T1D"}]},{"@type":"WebSite","@id":"https:\/\/periproxy.com\/#website","url":"https:\/\/periproxy.com\/","name":"R\u00e9seau PROxy","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/periproxy.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-CA"}]}},"_links":{"self":[{"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/pages\/5732","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/users\/546"}],"replies":[{"embeddable":true,"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/comments?post=5732"}],"version-history":[{"count":11,"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/pages\/5732\/revisions"}],"predecessor-version":[{"id":7612,"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/pages\/5732\/revisions\/7612"}],"wp:attachment":[{"href":"https:\/\/periproxy.com\/en\/wp-json\/wp\/v2\/media?parent=5732"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}