Voir le produit
Inscrivez-vous à notre newsletter !
<!-- Begin Brevo Form -->
<!-- START - We recommend to place the below code in head tag of your website html -->
<style>
@font-face {
font-display: block;
font-family: Roboto;
src: url(https://assets.brevo.com/font/Roboto/Latin/normal/normal/7529907e9eaf8ebb5220c5f9850e3811.woff2) format("woff2"), url(https://assets.brevo.com/font/Roboto/Latin/normal/normal/25c678feafdc175a70922a116c9be3e7.woff) format("woff")
}
@font-face {
font-display: fallback;
font-family: Roboto;
font-weight: 600;
src: url(https://assets.brevo.com/font/Roboto/Latin/medium/normal/6e9caeeafb1f3491be3e32744bc30440.woff2) format("woff2"), url(https://assets.brevo.com/font/Roboto/Latin/medium/normal/71501f0d8d5aa95960f6475d5487d4c2.woff) format("woff")
}
@font-face {
font-display: fallback;
font-family: Roboto;
font-weight: 700;
src: url(https://assets.brevo.com/font/Roboto/Latin/bold/normal/3ef7cf158f310cf752d5ad08cd0e7e60.woff2) format("woff2"), url(https://assets.brevo.com/font/Roboto/Latin/bold/normal/ece3a1d82f18b60bcce0211725c476aa.woff) format("woff")
}
#sib-container input:-ms-input-placeholder {
text-align: left;
font-family: Helvetica, sans-serif;
color: #6e747b;
}
#sib-container input::placeholder {
text-align: left;
font-family: Helvetica, sans-serif;
color: #6e747b;
}
#sib-container textarea::placeholder {
text-align: left;
font-family: Helvetica, sans-serif;
color: #6e747b;
}
#sib-container a {
text-decoration: underline;
color: #2BB2FC;
}
</style>
<link rel="stylesheet" href="https://sibforms.com/forms/end-form/build/sib-styles.css">
<!-- END - We recommend to place the above code in head tag of your website html -->
<!-- START - We recommend to place the below code where you want the form in your website html -->
<div class="sib-form" style="text-align: center;
background-image: url(https://img.mailinblue.com/1460212/images/content_library/original/699eca8049d9a3966e9eee2f.jpg); background-size: cover; background-repeat: no-repeat; background-position: center center; ">
<div id="sib-form-container" class="sib-form-container">
<div id="error-message" class="sib-form-message-panel" style="font-size:16px; text-align:left; font-family:Helvetica, sans-serif; color:#661d1d; background-color:#ffeded; border-radius:3px; border-color:#ff4949;max-width:540px;">
<div class="sib-form-message-panel__text sib-form-message-panel__text--center">
<svg viewBox="0 0 512 512" class="sib-icon sib-notification__icon">
<path d="M256 40c118.621 0 216 96.075 216 216 0 119.291-96.61 216-216 216-119.244 0-216-96.562-216-216 0-119.203 96.602-216 216-216m0-32C119.043 8 8 119.083 8 256c0 136.997 111.043 248 248 248s248-111.003 248-248C504 119.083 392.957 8 256 8zm-11.49 120h22.979c6.823 0 12.274 5.682 11.99 12.5l-7 168c-.268 6.428-5.556 11.5-11.99 11.5h-8.979c-6.433 0-11.722-5.073-11.99-11.5l-7-168c-.283-6.818 5.167-12.5 11.99-12.5zM256 340c-15.464 0-28 12.536-28 28s12.536 28 28 28 28-12.536 28-28-12.536-28-28-28z" />
</svg>
<span class="sib-form-message-panel__inner-text">
Nous n'avons pas pu confirmer votre inscription.
</span>
</div>
</div>
<div></div>
<div id="success-message" class="sib-form-message-panel" style="font-size:16px; text-align:left; font-family:Helvetica, sans-serif; color:#085229; background-color:#e7faf0; border-radius:3px; border-color:#13ce66;max-width:540px;">
<div class="sib-form-message-panel__text sib-form-message-panel__text--center">
<svg viewBox="0 0 512 512" class="sib-icon sib-notification__icon">
<path d="M256 8C119.033 8 8 119.033 8 256s111.033 248 248 248 248-111.033 248-248S392.967 8 256 8zm0 464c-118.664 0-216-96.055-216-216 0-118.663 96.055-216 216-216 118.664 0 216 96.055 216 216 0 118.663-96.055 216-216 216zm141.63-274.961L217.15 376.071c-4.705 4.667-12.303 4.637-16.97-.068l-85.878-86.572c-4.667-4.705-4.637-12.303.068-16.97l8.52-8.451c4.705-4.667 12.303-4.637 16.97.068l68.976 69.533 163.441-162.13c4.705-4.667 12.303-4.637 16.97.068l8.451 8.52c4.668 4.705 4.637 12.303-.068 16.97z" />
</svg>
<span class="sib-form-message-panel__inner-text">
Votre inscription est confirmée.
</span>
</div>
</div>
<div></div>
<div id="sib-container" class="sib-container--large sib-container--vertical" style="text-align:center; background-color:rgba(255,255,255,0.78); max-width:540px; border-radius:25px; border-width:0px; border-color:#43484f; border-style:solid; direction:ltr">
<form id="sib-form" method="POST" action="https://a43e8898.sibforms.com/serve/MUIFAJeNYw3sxAd43dmkKa42MrpyKRt3pw7kaRH2BLL-5PhFtPszybEowIOf5YUeaS8ZAVlKAaoC6qTmZ9K6MwQ9t9S9tCEsPPiuQfwH1zpynV4KSrFMgZgbS7v8lG5uZx_nSH9pzgv9YyIvlDovyIVDzgM6fBSWvdHEfVi73NpOrKHrtLx7i0HV0hPJxrDDzJAwsy82Pr-nB_pG" data-type="subscription">
<div style="padding: 8px 0;">
<div class="sib-input sib-form-block">
<div class="form__entry entry_block">
<div class="form__label-row ">
<label class="entry__label" style="font-weight: 700; text-align:left; font-size:16px; text-align:left; font-weight:700; font-family:Helvetica, sans-serif; color:#000000;" for="EMAIL" data-required="*">Entrez votre EMAIL</label>
<div class="entry__field">
<input class="input " type="text" id="EMAIL" name="EMAIL" autocomplete="off" placeholder="EMAIL" data-required="true" required />
</div>
</div>
<label class="entry__error entry__error--primary" style="font-size:16px; text-align:left; font-family:Helvetica, sans-serif; color:#661d1d; background-color:#ffeded; border-radius:3px; border-color:#ff4949;">
</label>
</div>
</div>
</div>
<div style="padding: 8px 0;">
<div class="sib-checkbox-group sib-form-block" data-required="true">
<div class="form__entry entry_mcq">
<div class="form__label-row ">
<div style="">
<div class="entry__choice">
<label class="checkbox__label">
<input type="checkbox" class="input_replaced" name="lists_32[]" data-value="Je suis un particulier" value="213" data-required="true" />
<span class="checkbox checkbox_tick_positive"
style="margin-left:"
></span><span style="font-size:14px; text-align:left; font-family:Helvetica, sans-serif; color:#000000; background-color:transparent;">Je suis un particulier</span> </label>
</div>
<div class="entry__choice">
<label class="checkbox__label">
<input type="checkbox" class="input_replaced" name="lists_32[]" data-value="Je suis un professionnel de santé" value="216" data-required="true" />
<span class="checkbox checkbox_tick_positive"
style="margin-left:"
></span><span style="font-size:14px; text-align:left; font-family:Helvetica, sans-serif; color:#000000; background-color:transparent;">Je suis un professionnel de santé</span> </label>
</div>
</div>
</div>
<label class="entry__error entry__error--primary" style="font-size:16px; text-align:left; font-family:Helvetica, sans-serif; color:#661d1d; background-color:#ffeded; border-radius:3px; border-color:#ff4949;">
</label>
</div>
</div>
</div>
<div style="padding: 8px 0;">
<div class="sib-form-block" style="text-align: center">
<button class="sib-form-block__button sib-form-block__button-with-loader" style="font-size:16px; text-align:center; font-weight:700; font-family:Helvetica, sans-serif; color:#FFFFFF; background-color:#008cb5; border-radius:20px; border-width:0px;" form="sib-form" type="submit">
<svg class="icon clickable__icon progress-indicator__icon sib-hide-loader-icon" viewBox="0 0 512 512" style="">
<path d="M460.116 373.846l-20.823-12.022c-5.541-3.199-7.54-10.159-4.663-15.874 30.137-59.886 28.343-131.652-5.386-189.946-33.641-58.394-94.896-95.833-161.827-99.676C261.028 55.961 256 50.751 256 44.352V20.309c0-6.904 5.808-12.337 12.703-11.982 83.556 4.306 160.163 50.864 202.11 123.677 42.063 72.696 44.079 162.316 6.031 236.832-3.14 6.148-10.75 8.461-16.728 5.01z" />
</svg>
S'INSCRIRE
</button>
</div>
</div>
<input type="text" name="email_address_check" value="" class="input--hidden">
<input type="hidden" name="locale" value="fr">
</form>
</div>
</div>
</div>
<!-- END - We recommend to place the above code where you want the form in your website html -->
<!-- START - We recommend to place the below code in footer or bottom of your website html -->
<script>
window.REQUIRED_CODE_ERROR_MESSAGE = 'Veuillez choisir un code pays';
window.LOCALE = 'fr';
window.EMAIL_INVALID_MESSAGE = window.SMS_INVALID_MESSAGE = "Les informations que vous avez fournies ne sont pas valides. Veuillez vérifier le format du champ et réessayer.";
window.REQUIRED_ERROR_MESSAGE = "Vous devez renseigner ce champ. ";
window.GENERIC_INVALID_MESSAGE = "Les informations que vous avez fournies ne sont pas valides. Veuillez vérifier le format du champ et réessayer.";
window.REQUIRED_MULTISELECT_MESSAGE = 'Veuillez choisir au moins une option';
window.translation = {
common: {
selectedList: '{quantity} liste sélectionnée',
selectedLists: '{quantity} listes sélectionnées',
selectedOption: '{quantity} sélectionné',
selectedOptions: '{quantity} sélectionnés',
}
};
var AUTOHIDE = Boolean(0);
</script>
<script defer src="https://sibforms.com/forms/end-form/build/main.js"></script>
<!-- END - We recommend to place the above code in footer or bottom of your website html -->
<!-- End Brevo Form -->
