{"id":29289,"date":"2026-03-24T19:46:08","date_gmt":"2026-03-24T19:46:08","guid":{"rendered":"https:\/\/temovision.com\/?page_id=29289"},"modified":"2026-03-25T00:06:35","modified_gmt":"2026-03-25T00:06:35","slug":"submit-prescription","status":"publish","type":"page","link":"https:\/\/temovision.com\/fr\/submit-prescription\/","title":{"rendered":"Soumettre une ordonnance"},"content":{"rendered":"\n\n\n<p>Post a picture of your prescription script here. The information requested below is used to facilitate the delivery process.<\/p>\n\n\n<div class='fluentform ff-default fluentform_wrapper_2 ffs_default_wrap'><form data-form_id=\"2\" id=\"fluentform_2\" class=\"frm-fluent-form fluent_form_2 ff-el-form-top ff_form_instance_2_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_2_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Submit Prescription<\/legend>        <div\n                style=\"display: none!important; position: absolute!important; transform: translateX(1000%)!important;\"\n                class=\"ff-el-group ff-hpsf-container\"\n        >\n            <div class=\"ff-el-input--label asterisk-right\">\n                <label for=\"ff_2_item_sf\" aria-label=\"Notify\">\n                    Notify                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_2__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_2_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n                <input type=\"hidden\" id=\"__fluent_protection_token_2\" class=\"fluent-form-token-field\" name=\"__fluent_protection_token_2\">\n        <input type='hidden' name='__fluent_form_embded_post_id' value='29289' \/><input type=\"hidden\" id=\"_fluentform_2_fluentformnonce\" name=\"_fluentform_2_fluentformnonce\" value=\"b8cbf0b48b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/29289\" \/><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_file-upload_1' id='label_ff_2_file-upload_1' aria-label=\"Upload Prescription File\">Upload Prescription File<\/label><\/div><div class='ff-el-input--content'><label for='ff_2_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Choose a File<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_2_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\"  aria-invalid='false' aria-required=true><\/label><\/div><\/div><div data-type=\"name-element\" data-name=\"names_4\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_names_4_first_name_' id='label_ff_2_names_4_first_name_' >Patient Full Names<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_4[first_name]\" id=\"ff_2_names_4_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_numeric_field' id='label_ff_2_numeric_field' aria-label=\"Patient Age\">Patient Age<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric_field\" id=\"ff_2_numeric_field\" class=\"ff-el-form-control\" data-name=\"numeric_field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_dropdown' id='label_ff_2_dropdown' aria-label=\"Patient Gender\">Patient Gender<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_2_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_2_dropdown\"><option value=\"\">- Select -<\/option><option value=\"Male\"  >Male<\/option><option value=\"Female\"  >Female<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_email_1' id='label_ff_2_email_1' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_2_email_1\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_2_numeric-field_1' id='label_ff_2_numeric-field_1' aria-label=\"Phone no.\">Phone no.<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_1\" id=\"ff_2_numeric-field_1\" class=\"ff-el-form-control\" data-name=\"numeric-field_1\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Allergic to any Medications?\">Allergic to any Medications?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_ce31af4d422959239b45c2588faf2360'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_3_ce31af4d422959239b45c2588faf2360' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_0e80e8c442ea87da4c5313f3e35a1f74'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_3_0e80e8c442ea87da4c5313f3e35a1f74' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_2_input_text_6' id='label_ff_2_input_text_6' aria-label=\"List the medications you are allergic to.\">List the medications you are allergic to.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_2_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_2_description' id='label_ff_2_description' aria-label=\"Any Notes for the Pharmacist?\">Any Notes for the Pharmacist?<\/label><\/div><div 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