{"id":76,"date":"2026-04-08T05:19:58","date_gmt":"2026-04-08T05:19:58","guid":{"rendered":"http:\/\/ecopharmasupply.test\/be\/product-portfolio-request\/"},"modified":"2026-06-22T05:14:30","modified_gmt":"2026-06-22T05:14:30","slug":"envoyer-une-demande-de-produit","status":"publish","type":"page","link":"https:\/\/www.ecopharmasupply.com\/be\/fr\/envoyer-une-demande-de-produit\/","title":{"rendered":"Envoyer une demande de produit"},"content":{"rendered":"\t\t<div data-elementor-type=\"page\" data-elementor-id=\"76\" class=\"elementor elementor-76\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-12b6d230 hero-section e-flex e-con-boxed e-con e-parent\" data-id=\"12b6d230\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-52ea4846 e-con-full e-flex e-con e-child\" data-id=\"52ea4846\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-496a206b elementor-widget__width-initial eps-side-title elementor-widget elementor-widget-heading\" data-id=\"496a206b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Demande de produit<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7cfcd355 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"7cfcd355\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Besoin d&rsquo;un m\u00e9dicament sp\u00e9cifique ? Envoyez-nous votre demande et nous l&rsquo;examinerons imm\u00e9diatement pour vous aider \u00e0 trouver le traitement dont votre patient a besoin.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-6b5453ba product-request-form e-flex e-con-boxed e-con e-parent\" data-id=\"6b5453ba\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-765a70cc elementor-button-align-start elementor-widget__width-initial cform-acceptance btn-secondary hover-default-gradient elementor-widget elementor-widget-form\" data-id=\"765a70cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Envoyer une demande de produit\" aria-label=\"Envoyer une demande de produit\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"76\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"765a70cc\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Envoyer une demande de produit - Ecopharmasupply Belgique\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"76\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2564354 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2564354\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2564354]\" id=\"form-field-field_2564354\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Saisissez votre pr\u00e9nom\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1172113 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1172113\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de famille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_1172113]\" id=\"form-field-field_1172113\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Saisir le nom de famille\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_3321995 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3321995\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_3321995]\" id=\"form-field-field_3321995\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Saisissez votre adresse e-mail\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_786760 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_786760\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNum\u00e9ro de t\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_786760]\" id=\"form-field-field_786760\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Entrez votre num\u00e9ro de t\u00e9l\u00e9phone\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6405415 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6405415\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de la Pharmacie\/de l'H\u00f4pital\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6405415]\" id=\"form-field-field_6405415\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Saisir le nom de la pharmacie\/de l&#039;h\u00f4pital\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4ee70ad elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4ee70ad\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVeuillez d\u00e9crire votre besoin en produit\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_4ee70ad]\" id=\"form-field-field_4ee70ad\" rows=\"4\" placeholder=\"Saisir un message\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_374a286 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_374a286]\" id=\"form-field-field_374a286\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_374a286\">En cochant cette case, j'accepte la <a href=\"https:\/\/ecopharmasupply.com\/be\/fr\/privacy-cookie-statement-pluripharm-group\/\">politique de confidentialit\u00e9.<\/a> <span class=\"required\">*<\/span><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"22\" height=\"18\" viewBox=\"0 0 22 18\" fill=\"none\"><path d=\"M20.5 8.88893H0.5M20.5 8.88893L12.1064 0.5M20.5 8.88893L12.1064 16.8347\" stroke=\"#453538\" stroke-miterlimit=\"10\" stroke-linecap=\"round\"><\/path><\/svg>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-60dc244 e-con-full e-flex e-con e-child\" data-id=\"60dc244\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5e53ee13 elementor-widget__width-inherit elementor-widget elementor-widget-template\" data-id=\"5e53ee13\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"container\" data-elementor-id=\"37\" class=\"elementor elementor-37\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-34aed1ff e-con-full e-flex e-con e-child\" data-id=\"34aed1ff\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b1bc2d elementor-widget elementor-widget-image\" data-id=\"4b1bc2d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"90\" height=\"90\" src=\"https:\/\/www.ecopharmasupply.com\/be\/wp-content\/uploads\/sites\/3\/2026\/07\/ic_phone_white.svg\" class=\"attachment-full size-full wp-image-1287\" alt=\"\" title=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-29278217 e-con-full e-flex e-con e-child\" data-id=\"29278217\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-384c49d8 e-con-full e-flex e-con e-child\" data-id=\"384c49d8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-33e350f3 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"33e350f3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\">Questions g\u00e9n\u00e9rales<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-732de35 e-con-full e-flex e-con e-child\" data-id=\"732de35\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-35c9c88d elementor-widget-tablet__width-inherit elementor-widget elementor-widget-heading\" data-id=\"35c9c88d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<div class=\"elementor-heading-title elementor-size-default\"><a href=\"tel:+32 (0)56\/58.56.80\">+32 (0)56\/58.56.80<\/a><br \/><a href=\"mailto:nms@ecopharmasupply.com\">nms@ecopharmasupply.com<\/a><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Demande de produit Besoin d&rsquo;un m\u00e9dicament sp\u00e9cifique ? Envoyez-nous votre demande et nous l&rsquo;examinerons imm\u00e9diatement pour vous aider \u00e0 trouver le traitement dont votre patient a besoin.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-76","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/pages\/76","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/comments?post=76"}],"version-history":[{"count":72,"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/pages\/76\/revisions"}],"predecessor-version":[{"id":1243,"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/pages\/76\/revisions\/1243"}],"wp:attachment":[{"href":"https:\/\/www.ecopharmasupply.com\/be\/fr\/wp-json\/wp\/v2\/media?parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}