{"id":28351,"date":"2025-08-19T04:43:01","date_gmt":"2025-08-19T04:43:01","guid":{"rendered":"https:\/\/fillmed.com\/skin-diagnostic-form\/"},"modified":"2026-06-03T08:26:11","modified_gmt":"2026-06-03T08:26:11","slug":"skin-diagnostic-form","status":"publish","type":"page","link":"https:\/\/fillmed.com\/fr\/skin-diagnostic-form\/","title":{"rendered":"Skin Diagnostic Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css=&#8221;.vc_custom_1780473654375{padding-top: 0px !important;}&#8221;][vc_column]\n\t<div class=\"fml_skin_diagnostic_main_wrapper in\">\n\t\t<div class=\"fml-custom-layout\">\n\t\t\t<div class=\"fml-left-content\">\n\t\t\t\t<div id=\"form-placeholder-container\" class=\"fml-left-image\">\n\t\t\t\t\t<!-- <img decoding=\"async\" class=\"default-placeholder\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/1080x1080-2-EGERIES-MO-LI-SIMONAS-RGB-COLOR-FM-0124-WEB.webp\" alt=\"Form Image\" \/> -->\n\t\t\t\t\t<img decoding=\"async\" id=\"form-placeholder-image\" class=\"default-placeholder\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-01.webp\"\n\t\t\t\t\t\talt=\"Form Image\" \/>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"fml-right-content\">\n\t\t\t\t<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_72' style='display:none'><div id='gf_72' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">SKIN DIAGNOSTIC - Development FR<\/h2>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_72'  action='\/fr\/wp-json\/wp\/v2\/pages\/28351' data-formid='72' novalidate>\n        <div id='gf_progressbar_wrapper_72' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>23<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_custom' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_custom percentbar_4' style='width:4%; color:; background-color:#D8D8DC;'><span>4%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_72_1' class='gform_page step-1-wrapper' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_72' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_3\" 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_below field_validation_below gfield_visibility_visible\"  >  <div class=\"fml-step-header first-step\">\n            <span class=\"fml-step\">\u00c9tape 1<\/span>\n            <h2>\u00c0 propos <span>de vous<\/span><\/h2>\n            <p>\n               Afin d'assurer une prise en charge compl\u00e8te et personnalis\u00e9e, nous commen\u00e7ons par mieux vous conna\u00eetre. Cette section recueille des informations essentielles afin de soutenir votre consultation et de garantir des soins optimaux dispens\u00e9s par un professionnel qualifi\u00e9. Elle pose les bases d\u2019un programme adapt\u00e9, en accord avec vos objectifs et vos pr\u00e9occupations.\n            <\/p>\n        <\/div>\n        <!-- Gravity Form Shortcode -->\n        <?php echo do_shortcode('[gravityform id=\"1\" title=\"false\" description=\"false\" ajax=\"true\"]'); ?><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_72_1' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_2' class='gform_page step-2-wrapper' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_72_6\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class=\"gfield_label gform-field-label\"><h3>Pr\u00e9nom<\/h3><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_6'>\n                            \n                            <span id='input_72_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_72_6_3' value=''   aria-required='true'   placeholder='Catherine'  \/>\n                                                    <label for='input_72_6_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_108\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class=\"gfield_label gform-field-label\"><h3>Pays<\/h3><\/legend>    \n                    <div class='ginput_complex ginput_container has_country ginput_container_address gform-grid-row' id='input_72_108' >\n                        <input type='hidden' class='gform_hidden' name='input_108.4' id='input_72_108_4' value=''\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_72_108_6_container' >\n                                        <select name='input_108.6' id='input_72_108_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' selected='selected'>France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_72_108_6' id='input_72_108_6_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_72_109' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_109' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_3' class='gform_page' data-js='page-field-id-109' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_72_116\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline button_select 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\"><h3>Genre<\/h3><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_116'>\n\t\t\t<div class='gchoice gchoice_72_116_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Homme'  id='choice_72_116_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_116_0' id='label_72_116_0' class='gform-field-label gform-field-label--type-inline'>Homme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_116_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Femme' checked='checked' id='choice_72_116_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_116_1' id='label_72_116_1' class='gform-field-label gform-field-label--type-inline'>Femme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_116_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Autre'  id='choice_72_116_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_116_2' id='label_72_116_2' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_72_36\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>\u00c2ge<\/h3><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_36'>\n\t\t\t<div class='gchoice gchoice_72_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gquiz3642bfdb71'  id='choice_72_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_36_0' id='label_72_36_0' class='gform-field-label gform-field-label--type-inline'>18-24<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gquiz361afdcdb2'  id='choice_72_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_36_1' id='label_72_36_1' class='gform-field-label gform-field-label--type-inline'>25-34<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gquiz36a4ffbceb'  id='choice_72_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_36_2' id='label_72_36_2' class='gform-field-label gform-field-label--type-inline'>35-44<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_36_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gquiz36acff650d'  id='choice_72_36_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_36_3' id='label_72_36_3' class='gform-field-label gform-field-label--type-inline'>45-59<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_36_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gquiz3669642578'  id='choice_72_36_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_36_4' id='label_72_36_4' class='gform-field-label gform-field-label--type-inline'>+ 60<\/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_72_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_9' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_4' class='gform_page step-female-1-wrapper' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-01.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_37\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline button_select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Votre statut hormonal ?<\/h3><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_37'>\n\t\t\t<div class='gchoice gchoice_72_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='gquiz374f2d32a9'  id='choice_72_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_37_0' id='label_72_37_0' class='gform-field-label gform-field-label--type-inline'>Enceinte<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='gquiz37b7ed3a8f'  id='choice_72_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_37_1' id='label_72_37_1' class='gform-field-label gform-field-label--type-inline'>Allaitement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='gquiz376a24a100'  id='choice_72_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_37_2' id='label_72_37_2' class='gform-field-label gform-field-label--type-inline'>Aucun<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_37_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='gquiz373cfc48a0'  id='choice_72_37_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_37_3' id='label_72_37_3' class='gform-field-label gform-field-label--type-inline'>Autres<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_72_111\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_72_111'>&lt;h3&gt;Specify&lt;\/h3&gt;<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_111' id='input_72_111' type='text' value='' class='large'    placeholder='Specify' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_72_38\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline button-toggle button_select gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Avez-vous un traitement au long cours ?<\/h3><\/legend><div class='gfield_description' id='gfield_description_72_38'>(excluant les pilules contraceptives)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_38'>\n\t\t\t<div class='gchoice gchoice_72_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='gquiz3817674139'  id='choice_72_38_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_72_38\"   \/>\n\t\t\t\t\t<label for='choice_72_38_0' id='label_72_38_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='gquiz38771e9e0d'  id='choice_72_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_38_1' id='label_72_38_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/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_72_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_5' class='gform_page step-female-2-wrapper' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_113\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-03.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_16\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"fml-step-header\">\n\t\t\t\t\t\t<span class=\"fml-step\">\u00c9tape 2<\/span>\n\t\t\t\t\t\t<h2>Votre profil <span>beaut\u00e9<\/span><\/h2>\n\t\t\t\t\t\t<p>\nMaintenant que nous disposons d'une meilleure compr\u00e9hension de votre profil, approfondissons vos aspirations en mati\u00e8re de peau et de beaut\u00e9. Cette section vise \u00e0 mieux comprendre votre peau, vos pr\u00e9occupations ainsi que les am\u00e9liorations que vous souhaitez obtenir. Il s\u2019agit d\u2019une \u00e9tape essentielle pour nous permettre de personnaliser au mieux votre accompagnement.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<!-- Gravity Form Shortcode -->\n\t\t\t\t\t<?php echo do_shortcode('[gravityform id=\"1\" title=\"false\" description=\"false\" ajax=\"true\"]'); ?><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_72_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_17' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_6' class='gform_page step-female-3-wrapper' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_39\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-03.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_18\" class=\"gfield gfield--type-image_choice gfield--type-choice gfield--image-choice-appearance-card gfield--image-choice-style-square gfield--input-type-radio skin-type-wrapper 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\"><h3>Votre type de peau ?<\/h3><\/legend><div class='ginput_container ginput_container_radio ginput_container_image_choice ginput_container_image_choice--label-show ginput_container_image_choice--input-show'><div class=\"gfield_radio\" id=\"input_72_18\"><div class='gchoice gchoice_72_18_0'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img fetchpriority=\"high\" decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 1\" id=\"gchoice_image_72_18_0\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;NORMAL&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau est \u00e9quilibr\u00e9e, ni trop s\u00e8che ni trop grasse, et j&#039;ai rarement des imperfections.&lt;\/div&gt;'  id='choice_72_18_0' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_18_0\"\/>\n\t\t\t\t\t<label for='choice_72_18_0' id='label_72_18_0' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">NORMAL<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau est \u00e9quilibr\u00e9e, ni trop s\u00e8che ni trop grasse, et j'ai rarement des imperfections.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_18_1'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 2\" id=\"gchoice_image_72_18_1\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;MIXTE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau pr\u00e9sente \u00e0 la fois des zones grasses et s\u00e8ches, g\u00e9n\u00e9ralement avec une zone T grasse.&lt;\/div&gt;'  id='choice_72_18_1' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_18_1\"\/>\n\t\t\t\t\t<label for='choice_72_18_1' id='label_72_18_1' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">MIXTE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau pr\u00e9sente \u00e0 la fois des zones grasses et s\u00e8ches, g\u00e9n\u00e9ralement avec une zone T grasse.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_18_2'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 3\" id=\"gchoice_image_72_18_2\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;S\u00c8CHE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau est tendue ou rugueuse parce qu&#039;elle manque d&#039;hydratation.&lt;\/div&gt;'  id='choice_72_18_2' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_18_2\"\/>\n\t\t\t\t\t<label for='choice_72_18_2' id='label_72_18_2' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">S\u00c8CHE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau est tendue ou rugueuse parce qu'elle manque d'hydratation.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_18_3'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 4\" id=\"gchoice_image_72_18_3\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;GRASSE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau produit un exc\u00e8s de s\u00e9bum, ce qui la rend brillante avec des pores dilat\u00e9s.&lt;\/div&gt;'  id='choice_72_18_3' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_18_3\"\/>\n\t\t\t\t\t<label for='choice_72_18_3' id='label_72_18_3' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">GRASSE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau produit un exc\u00e8s de s\u00e9bum, ce qui la rend brillante avec des pores dilat\u00e9s.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_18_4'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 5\" id=\"gchoice_image_72_18_4\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;SENSIBLE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau \u00e0 tendance \u00e0 pr\u00e9senter des rougeurs, des irritations ou des r\u00e9actions aux produits et aux facteurs environnementaux.&lt;\/div&gt;'  id='choice_72_18_4' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_18_4\"\/>\n\t\t\t\t\t<label for='choice_72_18_4' id='label_72_18_4' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">SENSIBLE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau \u00e0 tendance \u00e0 pr\u00e9senter des rougeurs, des irritations ou des r\u00e9actions aux produits et aux facteurs environnementaux.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\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_72_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_19' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_7' class='gform_page step-female-4-wrapper' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_40\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-03.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_20\" class=\"gfield gfield--type-image_choice gfield--type-choice gfield--image-choice-appearance-card gfield--image-choice-style-square gfield--input-type-checkbox improve-wrapper 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\"><h3>Que souhaiteriez-vous am\u00e9liorer ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox ginput_container_image_choice ginput_container_image_choice--label-show ginput_container_image_choice--input-show'><div class=\"gfield_checkbox\" id=\"input_72_20\"><div class='gchoice gchoice_72_20_1'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 1\" id=\"gchoice_image_72_20_1\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Hydratation'  id='choice_72_20_1'   aria-describedby=\"gchoice_image_72_20_1\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_1' id='label_72_20_1' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tHydratation\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_2'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 2\" id=\"gchoice_image_72_20_2\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Fermet\u00e9'  id='choice_72_20_2'   aria-describedby=\"gchoice_image_72_20_2\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_2' id='label_72_20_2' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tFermet\u00e9\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_3'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 3\" id=\"gchoice_image_72_20_3\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='\u00c9clat'  id='choice_72_20_3'   aria-describedby=\"gchoice_image_72_20_3\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_3' id='label_72_20_3' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\t\u00c9clat\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_4'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 4\" id=\"gchoice_image_72_20_4\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='Rides'  id='choice_72_20_4'   aria-describedby=\"gchoice_image_72_20_4\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_4' id='label_72_20_4' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tRides\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_5'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"156\" height=\"162\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/09\/pigmentation.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 5\" id=\"gchoice_image_72_20_5\" loading=\"false\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='Pigmentation'  id='choice_72_20_5'   aria-describedby=\"gchoice_image_72_20_5\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_5' id='label_72_20_5' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tPigmentation\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_6'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"156\" height=\"162\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/09\/texture.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 6\" id=\"gchoice_image_72_20_6\" loading=\"false\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='Texture'  id='choice_72_20_6'   aria-describedby=\"gchoice_image_72_20_6\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_6' id='label_72_20_6' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tTexture\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_7'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"156\" height=\"162\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/09\/imperfections.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 7\" id=\"gchoice_image_72_20_7\" loading=\"false\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.7' type='checkbox'  value='Imperfections'  id='choice_72_20_7'   aria-describedby=\"gchoice_image_72_20_7\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_7' id='label_72_20_7' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tImperfections\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_20_8'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"156\" height=\"162\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/09\/contours.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 8\" id=\"gchoice_image_72_20_8\" loading=\"false\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.8' type='checkbox'  value='Contours'  id='choice_72_20_8'   aria-describedby=\"gchoice_image_72_20_8\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_20_8' id='label_72_20_8' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tContours\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\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_72_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_8' class='gform_page step-female-5-wrapper' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-03.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_105\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline button_select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Quel r\u00e9sultat aimeriez-vous obtenir ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_105'><div class='gchoice gchoice_72_105_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.1' type='checkbox'  value='gquiz105f502cf94'  id='choice_72_105_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_1' id='label_72_105_1' class='gform-field-label gform-field-label--type-inline'>Moins fatigu\u00e9(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.2' type='checkbox'  value='gquiz10586e83f01'  id='choice_72_105_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_2' id='label_72_105_2' class='gform-field-label gform-field-label--type-inline'>Moins triste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.3' type='checkbox'  value='gquiz1051f2bc718'  id='choice_72_105_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_3' id='label_72_105_3' class='gform-field-label gform-field-label--type-inline'>Moins rel\u00e2ch\u00e9(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.4' type='checkbox'  value='gquiz1057c31acde'  id='choice_72_105_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_4' id='label_72_105_4' class='gform-field-label gform-field-label--type-inline'>Moins s\u00e9v\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.5' type='checkbox'  value='gquiz105ceebcbd1'  id='choice_72_105_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_5' id='label_72_105_5' class='gform-field-label gform-field-label--type-inline'>Plus jeune<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.6' type='checkbox'  value='gquiz105ad7fd7c5'  id='choice_72_105_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_6' id='label_72_105_6' class='gform-field-label gform-field-label--type-inline'>Avoir des contours mieux d\u00e9finis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_105_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.7' type='checkbox'  value='gquiz1051b9663f9'  id='choice_72_105_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_105_7' id='label_72_105_7' class='gform-field-label gform-field-label--type-inline'>Avoir l'air plus masculin\/f\u00e9minin<\/label>\n\t\t\t\t\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_72_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_23' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_9' class='gform_page step-female-6-wrapper' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-03.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_43\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"face-map-main-wrapper\"> \n<h3 class=\"title\">Dans quel zone observez-vous des signes de vieillissement ou des pr\u00e9occupations particuli\u00e8res ?<\/h3>\n  <p class=\"subtitle\">(Utilisez la carte du visage pour indiquer pr\u00e9cis\u00e9ment les zones qui vous pr\u00e9occupent le plus)<\/p>\n\n  <!-- Face Map with Custom Checkboxes -->\n  <div class=\"face-map\">\n    <label class=\"marker forehead\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Forehead\" data-value=\"Forehead\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Front<\/span>\n    <\/label>\n\n    <label class=\"marker eyes\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Eyes\" data-value=\"Eyes\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Contour des yeux<\/span>\n    <\/label>\n\n    <label class=\"marker cheek\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Cheek\" data-value=\"Cheek\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Joues<\/span>\n    <\/label>\n\n    <label class=\"marker mouth\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Mouth\" data-value=\"Mouth\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">L\u00e8vres<\/span>\n    <\/label>\n\n    <label class=\"marker chin\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Chin\" data-value=\"Chin\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Menton<\/span>\n    <\/label>\n\n    <label class=\"marker neck\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Neck\" data-value=\"Neck\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Cou<\/span>\n    <\/label>\n  <\/div>\n  <\/div><\/div><fieldset id=\"field_72_44\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Female : Face Map<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_44'><div class='gchoice gchoice_72_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='Front'  id='choice_72_44_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_1' id='label_72_44_1' class='gform-field-label gform-field-label--type-inline'>Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='Contour des yeux'  id='choice_72_44_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_2' id='label_72_44_2' class='gform-field-label gform-field-label--type-inline'>Contour des yeux<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_44_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.3' type='checkbox'  value='Joues'  id='choice_72_44_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_3' id='label_72_44_3' class='gform-field-label gform-field-label--type-inline'>Joues<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_44_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.4' type='checkbox'  value='L\u00e8vres'  id='choice_72_44_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_4' id='label_72_44_4' class='gform-field-label gform-field-label--type-inline'>L\u00e8vres<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_44_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.5' type='checkbox'  value='Menton'  id='choice_72_44_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_5' id='label_72_44_5' class='gform-field-label gform-field-label--type-inline'>Menton<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_44_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.6' type='checkbox'  value='Cou'  id='choice_72_44_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_44_6' id='label_72_44_6' class='gform-field-label gform-field-label--type-inline'>Cou<\/label>\n\t\t\t\t\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_72_46' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_46' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_10' class='gform_page step-female-7-wrapper' data-js='page-field-id-46' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_47\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" class=\"gender_female\" src=\"https:\/\/fillmed.test\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-05.webp\" alt=\"Your Image Description\" \/>\n\n<img decoding=\"async\" class=\"gender_other\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_49\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"fml-step-header\">\n\t\t\t\t\t\t<span class=\"fml-step\">\u00c9tape 3<\/span>\n\t\t\t\t\t\t<h2>Votre <span>style de vie<\/span><\/h2>\n\t\t\t\t\t\t<p>\nMaintenant que nous avons une vision plus claire de votre profil et de vos objectifs beaut\u00e9, explorons la mani\u00e8re dont votre mode de vie influence votre peau et votre bien-\u00eatre global. Cette section se concentre sur les habitudes et les facteurs cl\u00e9s qui ont un impact sur votre peau au quotidien. Compl\u00e9tez cette derni\u00e8re \u00e9tape afin d\u2019affiner votre pr\u00e9-consultation.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<!-- Gravity Form Shortcode -->\n\t\t\t\t\t<?php echo do_shortcode('[gravityform id=\"1\" title=\"false\" description=\"false\" ajax=\"true\"]'); ?><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_72_48' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_48' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_11' class='gform_page step-female-8-wrapper' data-js='page-field-id-48' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_50\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" class=\"gender_female\" src=\"https:\/\/fillmed.test\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-05.webp\" alt=\"Your Image Description\" \/>\n\n<img decoding=\"async\" class=\"gender_other\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_51\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>L'une des situations suivantes vous concerne-t-elle ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_51'><div class='gchoice gchoice_72_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='gquiz51219ede3c'  id='choice_72_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_1' id='label_72_51_1' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-119-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='gquiz51eaacdc84'  id='choice_72_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_2' id='label_72_51_2' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-120-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='gquiz514804cf3f'  id='choice_72_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_3' id='label_72_51_3' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-121-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.4' type='checkbox'  value='gquiz5182a945cd'  id='choice_72_51_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_4' id='label_72_51_4' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Stress.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.5' type='checkbox'  value='gquiz51912fb162'  id='choice_72_51_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_5' id='label_72_51_5' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-123-\u2013-12.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.6' type='checkbox'  value='gquiz519b355a1b'  id='choice_72_51_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_6' id='label_72_51_6' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-127-\u2013-11.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.7' type='checkbox'  value='gquiz516fcf2e97'  id='choice_72_51_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_7' id='label_72_51_7' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-126-\u2013-12.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.8' type='checkbox'  value='gquiz51ba23f2a0'  id='choice_72_51_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_8' id='label_72_51_8' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Pollution.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.9' type='checkbox'  value='gquiz5194f44ab1'  id='choice_72_51_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_9' id='label_72_51_9' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-124-\u2013-17.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_51_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.11' type='checkbox'  value='gquiz5181ab5913'  id='choice_72_51_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_51_11' id='label_72_51_11' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Groupe-2269.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_72_106\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >L&#039;une des situations suivantes vous concerne-t-elle ? [Female Hidden]<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_106'><div class='gchoice gchoice_72_106_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.1' type='checkbox'  value='gquiz10600baff3b'  id='choice_72_106_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_1' id='label_72_106_1' class='gform-field-label gform-field-label--type-inline'>Tabagisme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.2' type='checkbox'  value='gquiz1062853b80a'  id='choice_72_106_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_2' id='label_72_106_2' class='gform-field-label gform-field-label--type-inline'>R\u00e9gime riche en sucres ou en glucides<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.3' type='checkbox'  value='gquiz1062f82e2e7'  id='choice_72_106_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_3' id='label_72_106_3' class='gform-field-label gform-field-label--type-inline'>Exposition solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.4' type='checkbox'  value='gquiz1068c7e3c7d'  id='choice_72_106_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_4' id='label_72_106_4' class='gform-field-label gform-field-label--type-inline'>Stress<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.5' type='checkbox'  value='gquiz106720651da'  id='choice_72_106_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_5' id='label_72_106_5' class='gform-field-label gform-field-label--type-inline'>Manque de sommeil ou sommeil irr\u00e9gulier<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.6' type='checkbox'  value='gquiz106e30afa22'  id='choice_72_106_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_6' id='label_72_106_6' class='gform-field-label gform-field-label--type-inline'>Alimentation \u00e9quilibr\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.7' type='checkbox'  value='gquiz106d72fa457'  id='choice_72_106_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_7' id='label_72_106_7' class='gform-field-label gform-field-label--type-inline'>Consommation d'alcool<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.8' type='checkbox'  value='gquiz1061f374e83'  id='choice_72_106_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_8' id='label_72_106_8' class='gform-field-label gform-field-label--type-inline'>Pollution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.9' type='checkbox'  value='gquiz1062fb4ee77'  id='choice_72_106_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_9' id='label_72_106_9' class='gform-field-label gform-field-label--type-inline'>Exercice physique r\u00e9gulier<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_106_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_106.11' type='checkbox'  value='gquiz1062887c8dc'  id='choice_72_106_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_106_11' id='label_72_106_11' class='gform-field-label gform-field-label--type-inline'>Lumi\u00e8re bleue<\/label>\n\t\t\t\t\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_72_52' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_52' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_12' class='gform_page step-female-9-wrapper' data-js='page-field-id-52' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_53\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" class=\"gender_female\" src=\"https:\/\/fillmed.test\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-05.webp\" alt=\"Your Image Description\" \/>\n\n<img decoding=\"async\" class=\"gender_other\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_56\" 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_below field_validation_below gfield_visibility_visible\"  ><style>\n  .routine-main-wrapper {\n    max-width: 1000px;\n    margin: auto;\n    padding: 20px;\n    font-family: Arial, sans-serif;\n  }\n\n  .routine-container {\n    display: flex;\n    gap: 30px;\n    margin-bottom: 30px;\n  }\n\n  .routine-box {\n    flex: 1;\n    border: 2px dashed #ccc;\n    padding: 10px;\n    border-radius: 10px;\n  }\n\n  .routine-title {\n    font-weight: bold;\n    margin-bottom: 10px;\n    display: flex;\n    align-items: center;\n    gap: 10px;\n  }\n\n  .drop-zone {\n    min-height: 120px;\n    width: 100%;\n    padding: 10px;\n    border-radius: 8px;\n  }\n\n  .drop-hover {\n    background-color: #e6f7ff !important;\n  }\n\n  .product-list {\n    display: flex;\n    flex-wrap: wrap;\n    gap: 15px;\n  }\n\n  .product-item img {\n    max-width: 100%;\n    max-height: 100%;\n  }\n\n  .product-item {\n    position: relative;\n    cursor: pointer;\n  }\n\n\n<\/style>\n\n<div class=\"routine-main-wrapper\">\n  <div class=\"section-title routine-title-main\"><h3>Votre routine beaut\u00e9<\/h3><\/div>\n\n  <div class=\"routine-container\">\n    <div class=\"routine-box\" id=\"am-routine\">\n      <div class=\"routine-title\">\n        <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/sun.svg\" alt=\"AM\" \/>\n        Routine du <span class=\"sm-hidden\">matin<\/span>\n      <\/div>\n      <div class=\"drop-zone ui-droppable\" id=\"am-drop-zone\">\n        <!-- Preload all products -->\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"cleanser\" style=\"margin-bottom: 5px;\" id=\"cleanser\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"serum\" style=\"margin-bottom: 5px;\" id=\"serum\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"moisturizer\" style=\"margin-bottom: 5px;\" id=\"moisturizer\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"sunscreen\" style=\"margin-bottom: 5px;\" id=\"sunscreen\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"makeup\" style=\"margin-bottom: 5px;\" id=\"makeup\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"nothing\" style=\"margin-bottom: 5px;\" id=\"nothing\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" draggable=\"false\" \/>\n        <\/div>\n      <\/div>\n    <\/div>\n\n    <div class=\"routine-box\" id=\"pm-routine\">\n      <div class=\"routine-title\">\n        <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/moon.svg\" alt=\"PM\" \/>\n        Routine du <span class=\"sm-hidden\">soir<\/span>\n      <\/div>\n      <div class=\"drop-zone ui-droppable\" id=\"pm-drop-zone\">\n        <!-- Preload all products -->\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"cleanser\" style=\"margin-bottom: 5px;\" id=\"cleanser-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"serum\" style=\"margin-bottom: 5px;\" id=\"serum-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"moisturizer\" style=\"margin-bottom: 5px;\" id=\"moisturizer-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"sunscreen\" style=\"margin-bottom: 5px;\" id=\"sunscreen-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"makeup\" style=\"margin-bottom: 5px;\" id=\"makeup-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"nothing\" style=\"margin-bottom: 5px;\" id=\"nothing-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" draggable=\"false\" \/>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/div>\n  <div class=\"section-title\"><h3>Produits utilis\u00e9s :<\/h3><\/div>\n  <p>(Faire glisser dans les cases)<\/p>\n\n  <div class=\"product-list\">\n    <div class=\"product-item\" id=\"cleanser\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"serum\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"moisturizer\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"sunscreen\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"makeup\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"nothing\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" \/>\n    <\/div>\n  <\/div>\n<\/div><\/div><fieldset id=\"field_72_54\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Routine du matin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_54'><div class='gchoice gchoice_72_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='gquiz5418f91d00'  id='choice_72_54_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_1' id='label_72_54_1' class='gform-field-label gform-field-label--type-inline'>Nettoyant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='gquiz547bb61ae7'  id='choice_72_54_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_2' id='label_72_54_2' class='gform-field-label gform-field-label--type-inline'>S\u00e9rum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='gquiz5437550243'  id='choice_72_54_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_3' id='label_72_54_3' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me hydratante<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_54_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.4' type='checkbox'  value='gquiz549bbfacdf'  id='choice_72_54_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_4' id='label_72_54_4' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_54_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.5' type='checkbox'  value='gquiz548334619a'  id='choice_72_54_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_5' id='label_72_54_5' class='gform-field-label gform-field-label--type-inline'>Maquillage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_54_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.6' type='checkbox'  value='gquiz548707b427'  id='choice_72_54_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_54_6' id='label_72_54_6' class='gform-field-label gform-field-label--type-inline'>Rien<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_72_55\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Routine du soir<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_55'><div class='gchoice gchoice_72_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='gquiz5418f91d00'  id='choice_72_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_1' id='label_72_55_1' class='gform-field-label gform-field-label--type-inline'>Nettoyant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='gquiz547bb61ae7'  id='choice_72_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_2' id='label_72_55_2' class='gform-field-label gform-field-label--type-inline'>S\u00e9rum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='gquiz5437550243'  id='choice_72_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_3' id='label_72_55_3' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me hydratante<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='gquiz549bbfacdf'  id='choice_72_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_4' id='label_72_55_4' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='gquiz548334619a'  id='choice_72_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_5' id='label_72_55_5' class='gform-field-label gform-field-label--type-inline'>Maquillage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='gquiz548707b427'  id='choice_72_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_55_6' id='label_72_55_6' class='gform-field-label gform-field-label--type-inline'>Rien<\/label>\n\t\t\t\t\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_72_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_58' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_13' class='gform_page step-female-10-wrapper' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_115\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" class=\"gender_female\" src=\"https:\/\/fillmed.test\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-05.webp\" alt=\"Your Image Description\" \/>\n\n<img decoding=\"async\" class=\"gender_other\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_59\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline button-toggle button_select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Avez-vous d\u00e9j\u00e0 r\u00e9alis\u00e9 des traitements esth\u00e9tiques ou cosm\u00e9tiques ?<\/h3><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_59'>\n\t\t\t<div class='gchoice gchoice_72_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='gquiz3817674139'  id='choice_72_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_59_0' id='label_72_59_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='gquiz59c45e94c2'  id='choice_72_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_59_1' id='label_72_59_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/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_72_64' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_64' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_14' class='gform_page step-female-2-wrapper' data-js='page-field-id-64' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_65\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-04.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_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_below field_validation_below gfield_visibility_visible\"  ><div class=\"fml-step-header\">\n\t\t\t\t\t\t<span class=\"fml-step\">\u00c9tape 2<\/span>\n\t\t\t\t\t\t<h2>Votre profil <span>beaut\u00e9<\/span><\/h2>\n\t\t\t\t\t\t<p>\nMaintenant que nous disposons d'une meilleure compr\u00e9hension de votre profil, approfondissons vos aspirations en mati\u00e8re de peau et de beaut\u00e9. Cette section vise \u00e0 mieux comprendre votre peau, vos pr\u00e9occupations ainsi que les am\u00e9liorations que vous souhaitez obtenir. Il s\u2019agit d\u2019une \u00e9tape essentielle pour nous permettre de personnaliser au mieux votre accompagnement.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<!-- Gravity Form Shortcode -->\n\t\t\t\t\t<?php echo do_shortcode('[gravityform id=\"1\" title=\"false\" description=\"false\" ajax=\"true\"]'); ?><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_72_67' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_67' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_15' class='gform_page' data-js='page-field-id-67' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_68\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-04.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_69\" class=\"gfield gfield--type-image_choice gfield--type-choice gfield--image-choice-appearance-card gfield--image-choice-style-square gfield--input-type-radio gfield--width-full skin-type-wrapper 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\"><h3>Votre type de peau ?<\/h3><\/legend><div class='ginput_container ginput_container_radio ginput_container_image_choice ginput_container_image_choice--label-show ginput_container_image_choice--input-show'><div class=\"gfield_radio\" id=\"input_72_69\"><div class='gchoice gchoice_72_69_0'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 1\" id=\"gchoice_image_72_69_0\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-normal-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;NORMAL&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau est \u00e9quilibr\u00e9e, ni trop s\u00e8che ni trop grasse, et j&#039;ai rarement des imperfections.&lt;\/div&gt;'  id='choice_72_69_0' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_69_0\"\/>\n\t\t\t\t\t<label for='choice_72_69_0' id='label_72_69_0' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">NORMAL<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau est \u00e9quilibr\u00e9e, ni trop s\u00e8che ni trop grasse, et j'ai rarement des imperfections.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_69_1'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 2\" id=\"gchoice_image_72_69_1\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-combination-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;MIXTE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau pr\u00e9sente \u00e0 la fois des zones grasses et s\u00e8ches, g\u00e9n\u00e9ralement avec une zone T grasse.&lt;\/div&gt;'  id='choice_72_69_1' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_69_1\"\/>\n\t\t\t\t\t<label for='choice_72_69_1' id='label_72_69_1' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">MIXTE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau pr\u00e9sente \u00e0 la fois des zones grasses et s\u00e8ches, g\u00e9n\u00e9ralement avec une zone T grasse.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_69_2'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 3\" id=\"gchoice_image_72_69_2\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-dry-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;S\u00c8CHE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau est tendue ou rugueuse parce qu&#039;elle manque d&#039;hydratation.&lt;\/div&gt;'  id='choice_72_69_2' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_69_2\"\/>\n\t\t\t\t\t<label for='choice_72_69_2' id='label_72_69_2' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">S\u00c8CHE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau est tendue ou rugueuse parce qu'elle manque d'hydratation.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_69_3'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 4\" id=\"gchoice_image_72_69_3\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-oily-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;GRASSE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau produit un exc\u00e8s de s\u00e9bum, ce qui la rend brillante avec des pores dilat\u00e9s.&lt;\/div&gt;'  id='choice_72_69_3' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_69_3\"\/>\n\t\t\t\t\t<label for='choice_72_69_3' id='label_72_69_3' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">GRASSE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau produit un exc\u00e8s de s\u00e9bum, ce qui la rend brillante avec des pores dilat\u00e9s.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_72_69_4'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"400\" height=\"1102\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive.jpg\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 5\" id=\"gchoice_image_72_69_4\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive.jpg 400w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive-109x300.jpg 109w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/skin-diag-sensitive-372x1024.jpg 372w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='&lt;div class=&quot;skin-diag-25-title-img-choice&quot;&gt;SENSIBLE&lt;\/div&gt;&lt;div class=&quot;skin-diag-25-text-img-choice&quot;&gt;Ma peau \u00e0 tendance \u00e0 pr\u00e9senter des rougeurs, des irritations ou des r\u00e9actions aux produits et aux facteurs environnementaux.&lt;\/div&gt;'  id='choice_72_69_4' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_72_69_4\"\/>\n\t\t\t\t\t<label for='choice_72_69_4' id='label_72_69_4' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t<div class=\"skin-diag-25-title-img-choice\">SENSIBLE<\/div><div class=\"skin-diag-25-text-img-choice\">Ma peau \u00e0 tendance \u00e0 pr\u00e9senter des rougeurs, des irritations ou des r\u00e9actions aux produits et aux facteurs environnementaux.<\/div>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\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_72_70' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_70' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_16' class='gform_page step-female-4-wrapper' data-js='page-field-id-70' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_71\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-04.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_72\" class=\"gfield gfield--type-image_choice gfield--type-choice gfield--image-choice-appearance-card gfield--image-choice-style-square gfield--input-type-checkbox gfield--width-full improve-wrapper 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\"><h3>Que souhaiteriez-vous am\u00e9liorer ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox ginput_container_image_choice ginput_container_image_choice--label-show ginput_container_image_choice--input-show'><div class=\"gfield_checkbox\" id=\"input_72_72\"><div class='gchoice gchoice_72_72_1'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 1\" id=\"gchoice_image_72_72_1\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-160-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.1' type='checkbox'  value='Hydratation'  id='choice_72_72_1'   aria-describedby=\"gchoice_image_72_72_1\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_1' id='label_72_72_1' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tHydratation\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_2'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 2\" id=\"gchoice_image_72_72_2\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-161-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.2' type='checkbox'  value='Fermet\u00e9'  id='choice_72_72_2'   aria-describedby=\"gchoice_image_72_72_2\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_2' id='label_72_72_2' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tFermet\u00e9\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_3'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 3\" id=\"gchoice_image_72_72_3\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-162-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.3' type='checkbox'  value='\u00c9clat'  id='choice_72_72_3'   aria-describedby=\"gchoice_image_72_72_3\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_3' id='label_72_72_3' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\t\u00c9clat\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_4'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"316\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 4\" id=\"gchoice_image_72_72_4\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-163-\u2013-5-296x300.png 296w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.4' type='checkbox'  value='Rides'  id='choice_72_72_4'   aria-describedby=\"gchoice_image_72_72_4\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_4' id='label_72_72_4' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tRides\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_5'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"324\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Pigmentation.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 5\" id=\"gchoice_image_72_72_5\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Pigmentation.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Pigmentation-289x300.png 289w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.5' type='checkbox'  value='Pigmentation'  id='choice_72_72_5'   aria-describedby=\"gchoice_image_72_72_5\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_5' id='label_72_72_5' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tPigmentation\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_6'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"324\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Texture.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 6\" id=\"gchoice_image_72_72_6\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Texture.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Texture-289x300.png 289w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.6' type='checkbox'  value='Texture'  id='choice_72_72_6'   aria-describedby=\"gchoice_image_72_72_6\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_6' id='label_72_72_6' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tTexture\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_7'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"324\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Imperfections.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 7\" id=\"gchoice_image_72_72_7\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Imperfections.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Imperfections-289x300.png 289w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.7' type='checkbox'  value='Imperfections'  id='choice_72_72_7'   aria-describedby=\"gchoice_image_72_72_7\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_7' id='label_72_72_7' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tImperfections\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t<\/div><div class='gchoice gchoice_72_72_8'>\n\t\t\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><img decoding=\"async\" width=\"312\" height=\"324\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Contours.png\" class=\"gfield-choice-image\" alt=\"Image pour le nombre de choix 8\" id=\"gchoice_image_72_72_8\" loading=\"false\" srcset=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Contours.png 312w, https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Contours-289x300.png 289w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/div>\n\t\t\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.8' type='checkbox'  value='Contours'  id='choice_72_72_8'   aria-describedby=\"gchoice_image_72_72_8\"\/>\n\t\t\t\t\t\t\t<label for='choice_72_72_8' id='label_72_72_8' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\t\t\tContours\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\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_72_73' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_73' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_17' class='gform_page' data-js='page-field-id-73' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_77\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-04.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_104\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline button_select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Quel r\u00e9sultat aimeriez-vous obtenir ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_104'><div class='gchoice gchoice_72_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='gquiz104f5de69c8'  id='choice_72_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_1' id='label_72_104_1' class='gform-field-label gform-field-label--type-inline'>Moins fatigu\u00e9(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='gquiz1049351990a'  id='choice_72_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_2' id='label_72_104_2' class='gform-field-label gform-field-label--type-inline'>Moins triste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='gquiz1044453fd4f'  id='choice_72_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_3' id='label_72_104_3' class='gform-field-label gform-field-label--type-inline'>Moins rel\u00e2ch\u00e9(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.4' type='checkbox'  value='gquiz104f0c70489'  id='choice_72_104_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_4' id='label_72_104_4' class='gform-field-label gform-field-label--type-inline'>Moins s\u00e9v\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.5' type='checkbox'  value='gquiz104a2a3333e'  id='choice_72_104_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_5' id='label_72_104_5' class='gform-field-label gform-field-label--type-inline'>Plus jeune<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.6' type='checkbox'  value='gquiz10407930a1f'  id='choice_72_104_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_6' id='label_72_104_6' class='gform-field-label gform-field-label--type-inline'>Avoir des contours mieux d\u00e9finis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_104_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.7' type='checkbox'  value='gquiz104d5c5dc32'  id='choice_72_104_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_104_7' id='label_72_104_7' class='gform-field-label gform-field-label--type-inline'>Avoir l'air plus masculin\/f\u00e9minin<\/label>\n\t\t\t\t\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_72_76' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_76' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_18' class='gform_page' data-js='page-field-id-76' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_74\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-04.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_78\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"face-map-main-wrapper\"> \n<h3 class=\"title\">Dans quel zone observez-vous des signes de vieillissement ou des pr\u00e9occupations particuli\u00e8res ?<\/h3>\n  <p class=\"subtitle\">(Utilisez la carte du visage pour indiquer pr\u00e9cis\u00e9ment les zones qui vous pr\u00e9occupent le plus)<\/p>\n\n  <!-- Face Map with Custom Checkboxes -->\n  <div class=\"face-map\">\n    <label class=\"marker forehead\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Forehead\" data-value=\"Forehead\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Front<\/span>\n    <\/label>\n\n    <label class=\"marker eyes\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Eyes\" data-value=\"Eyes\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Contour des yeux<\/span>\n    <\/label>\n\n    <label class=\"marker cheek\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Cheek\" data-value=\"Cheek\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Joues<\/span>\n    <\/label>\n\n    <label class=\"marker mouth\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Mouth\" data-value=\"Mouth\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">L\u00e8vres<\/span>\n    <\/label>\n\n    <label class=\"marker chin\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Chin\" data-value=\"Chin\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Menton<\/span>\n    <\/label>\n\n    <label class=\"marker neck\">\n      <input type=\"checkbox\" name=\"concern_area\" value=\"Neck\" data-value=\"Neck\" class=\"concern-checkbox\" \/>\n      <span class=\"circle-btn\"><\/span>\n      <span class=\"label\">Cou<\/span>\n    <\/label>\n  <\/div>\n  <\/div><\/div><fieldset id=\"field_72_79\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Male : Face Map<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_79'><div class='gchoice gchoice_72_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='Front'  id='choice_72_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_1' id='label_72_79_1' class='gform-field-label gform-field-label--type-inline'>Front<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_79_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.2' type='checkbox'  value='Contour des yeux'  id='choice_72_79_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_2' id='label_72_79_2' class='gform-field-label gform-field-label--type-inline'>Contour des yeux<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_79_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.3' type='checkbox'  value='Joues'  id='choice_72_79_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_3' id='label_72_79_3' class='gform-field-label gform-field-label--type-inline'>Joues<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_79_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.4' type='checkbox'  value='L\u00e8vres'  id='choice_72_79_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_4' id='label_72_79_4' class='gform-field-label gform-field-label--type-inline'>L\u00e8vres<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_79_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.5' type='checkbox'  value='Menton'  id='choice_72_79_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_5' id='label_72_79_5' class='gform-field-label gform-field-label--type-inline'>Menton<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_79_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.6' type='checkbox'  value='Cou'  id='choice_72_79_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_79_6' id='label_72_79_6' class='gform-field-label gform-field-label--type-inline'>Cou<\/label>\n\t\t\t\t\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_72_80' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_80' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_19' class='gform_page step-female-2-wrapper' data-js='page-field-id-80' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_81\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_82\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"fml-step-header\">\n\t\t\t\t\t\t<span class=\"fml-step\">\u00c9tape 3<\/span>\n\t\t\t\t\t\t<h2>Votre <span>style de vie<\/span><\/h2>\n\t\t\t\t\t\t<p>\nMaintenant que nous avons une vision plus claire de votre profil et de vos objectifs beaut\u00e9, explorons la mani\u00e8re dont votre mode de vie influence votre peau et votre bien-\u00eatre global. Cette section se concentre sur les habitudes et les facteurs cl\u00e9s qui ont un impact sur votre peau au quotidien. Compl\u00e9tez cette derni\u00e8re \u00e9tape afin d\u2019affiner votre pr\u00e9-consultation.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<!-- Gravity Form Shortcode -->\n\t\t\t\t\t<?php echo do_shortcode('[gravityform id=\"1\" title=\"false\" description=\"false\" ajax=\"true\"]'); ?><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_72_83' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_83' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_20' class='gform_page step-female-8-wrapper' data-js='page-field-id-83' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_20' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_85\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/b3jt5hapdomidqvmas2d.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_84\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>L'une des situations suivantes vous concerne-t-elle ?<\/h3><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_84'><div class='gchoice gchoice_72_84_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.1' type='checkbox'  value='gquiz51219ede3c'  id='choice_72_84_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_1' id='label_72_84_1' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-119-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.2' type='checkbox'  value='gquiz51eaacdc84'  id='choice_72_84_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_2' id='label_72_84_2' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-120-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.3' type='checkbox'  value='gquiz514804cf3f'  id='choice_72_84_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_3' id='label_72_84_3' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-121-\u2013-8.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.4' type='checkbox'  value='gquiz5182a945cd'  id='choice_72_84_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_4' id='label_72_84_4' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Stress.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.5' type='checkbox'  value='gquiz51912fb162'  id='choice_72_84_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_5' id='label_72_84_5' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-123-\u2013-12.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.6' type='checkbox'  value='gquiz519b355a1b'  id='choice_72_84_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_6' id='label_72_84_6' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-127-\u2013-11.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.7' type='checkbox'  value='gquiz516fcf2e97'  id='choice_72_84_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_7' id='label_72_84_7' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-126-\u2013-12.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.8' type='checkbox'  value='gquiz51ba23f2a0'  id='choice_72_84_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_8' id='label_72_84_8' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/07\/Pollution.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.9' type='checkbox'  value='gquiz5194f44ab1'  id='choice_72_84_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_9' id='label_72_84_9' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Composant-124-\u2013-17.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_84_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.11' type='checkbox'  value='gquiz5181ab5913'  id='choice_72_84_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_84_11' id='label_72_84_11' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/Groupe-2269.png\" \/><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_72_107\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >L&#039;une des situations suivantes vous concerne-t-elle ? [Male Hidden]<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_107'><div class='gchoice gchoice_72_107_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.1' type='checkbox'  value='gquiz10600baff3b'  id='choice_72_107_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_1' id='label_72_107_1' class='gform-field-label gform-field-label--type-inline'>Tabagisme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.2' type='checkbox'  value='gquiz1062853b80a'  id='choice_72_107_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_2' id='label_72_107_2' class='gform-field-label gform-field-label--type-inline'>R\u00e9gime riche en sucres ou en glucides<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.3' type='checkbox'  value='gquiz1062f82e2e7'  id='choice_72_107_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_3' id='label_72_107_3' class='gform-field-label gform-field-label--type-inline'>Exposition solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.4' type='checkbox'  value='gquiz1068c7e3c7d'  id='choice_72_107_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_4' id='label_72_107_4' class='gform-field-label gform-field-label--type-inline'>Stress<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.5' type='checkbox'  value='gquiz106720651da'  id='choice_72_107_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_5' id='label_72_107_5' class='gform-field-label gform-field-label--type-inline'>Manque de sommeil ou sommeil irr\u00e9gulier<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.6' type='checkbox'  value='gquiz106e30afa22'  id='choice_72_107_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_6' id='label_72_107_6' class='gform-field-label gform-field-label--type-inline'>Alilmentation \u00e9quilibr\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.7' type='checkbox'  value='gquiz106d72fa457'  id='choice_72_107_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_7' id='label_72_107_7' class='gform-field-label gform-field-label--type-inline'>Consommation d'alcool<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.8' type='checkbox'  value='gquiz1061f374e83'  id='choice_72_107_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_8' id='label_72_107_8' class='gform-field-label gform-field-label--type-inline'>Pollution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.9' type='checkbox'  value='gquiz1062fb4ee77'  id='choice_72_107_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_9' id='label_72_107_9' class='gform-field-label gform-field-label--type-inline'>Exercice physique r\u00e9gulier<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_107_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_107.11' type='checkbox'  value='gquiz1062887c8dc'  id='choice_72_107_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_107_11' id='label_72_107_11' class='gform-field-label gform-field-label--type-inline'>Lumi\u00e8re bleue<\/label>\n\t\t\t\t\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_72_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_86' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_21' class='gform_page step-female-9-wrapper' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_21' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_87\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/b3jt5hapdomidqvmas2d.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><div id=\"field_72_88\" 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_below field_validation_below gfield_visibility_visible\"  ><style>\n  .routine-main-wrapper {\n    max-width: 1000px;\n    margin: auto;\n    padding: 20px;\n    font-family: Arial, sans-serif;\n  }\n\n  .routine-container {\n    display: flex;\n    gap: 30px;\n    margin-bottom: 30px;\n  }\n\n  .routine-box {\n    flex: 1;\n    border: 2px dashed #ccc;\n    padding: 10px;\n    border-radius: 10px;\n  }\n\n  .routine-title {\n    font-weight: bold;\n    margin-bottom: 10px;\n    display: flex;\n    align-items: center;\n    gap: 10px;\n  }\n\n  .drop-zone {\n    min-height: 120px;\n    width: 100%;\n    padding: 10px;\n    border-radius: 8px;\n  }\n\n  .drop-hover {\n    background-color: #e6f7ff !important;\n  }\n\n  .product-list {\n    display: flex;\n    flex-wrap: wrap;\n    gap: 15px;\n  }\n\n  .product-item img {\n    max-width: 100%;\n    max-height: 100%;\n  }\n\n  .product-item {\n    position: relative;\n    cursor: pointer;\n  }\n\n\n<\/style>\n\n<div class=\"routine-main-wrapper\">\n  <div class=\"section-title routine-title-main\"><h3>Votre routine beaut\u00e9<\/h3><\/div>\n\n  <div class=\"routine-container\">\n    <div class=\"routine-box\" id=\"am-routine\">\n      <div class=\"routine-title\">\n        <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/sun.svg\" alt=\"AM\" \/>\n        Routine du <span class=\"sm-hidden\">matin<\/span>\n      <\/div>\n      <div class=\"drop-zone ui-droppable\" id=\"am-drop-zone\">\n        <!-- Preload all products -->\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"cleanser\" style=\"margin-bottom: 5px;\" id=\"cleanser\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"serum\" style=\"margin-bottom: 5px;\" id=\"serum\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"moisturizer\" style=\"margin-bottom: 5px;\" id=\"moisturizer\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"sunscreen\" style=\"margin-bottom: 5px;\" id=\"sunscreen\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"makeup\" style=\"margin-bottom: 5px;\" id=\"makeup\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"nothing\" style=\"margin-bottom: 5px;\" id=\"nothing\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" draggable=\"false\" \/>\n        <\/div>\n      <\/div>\n    <\/div>\n\n    <div class=\"routine-box\" id=\"pm-routine\">\n      <div class=\"routine-title\">\n        <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2025\/08\/moon.svg\" alt=\"PM\" \/>\n        Routine du <span class=\"sm-hidden\">soir<\/span>\n      <\/div>\n      <div class=\"drop-zone ui-droppable\" id=\"pm-drop-zone\">\n        <!-- Preload all products -->\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"cleanser\" style=\"margin-bottom: 5px;\" id=\"cleanser-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"serum\" style=\"margin-bottom: 5px;\" id=\"serum-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"moisturizer\" style=\"margin-bottom: 5px;\" id=\"moisturizer-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"sunscreen\" style=\"margin-bottom: 5px;\" id=\"sunscreen-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"makeup\" style=\"margin-bottom: 5px;\" id=\"makeup-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" draggable=\"false\" \/>\n        <\/div>\n        <div class=\"product-item ui-draggable ui-draggable-handle\" draggable=\"false\" data-product=\"nothing\" style=\"margin-bottom: 5px;\" id=\"nothing-pm\">\n          <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" draggable=\"false\" \/>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/div>\n  <div class=\"section-title\"><h3>Produits utilis\u00e9s :<\/h3><\/div>\n  <p>(Faire glisser dans les cases)<\/p>\n\n  <div class=\"product-list\">\n    <div class=\"product-item\" id=\"cleanser\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0001_nettoyant.png\" alt=\"Nettoyant\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"serum\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0004_serum.png\" alt=\"Serum\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"moisturizer\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0003_creme-hydratante.png\" alt=\"Cr\u00e8me Hydratante\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"sunscreen\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0005_creme-solaire.png\" alt=\"Cr\u00e8me Solaire\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"makeup\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0002_maquillage.png\" alt=\"Maquillage\" \/>\n    <\/div>\n    <div class=\"product-item\" id=\"nothing\">\n      <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/uploads\/2026\/06\/fillmed-skin-diag-_0000_rien.png\" alt=\"Rien\" \/>\n    <\/div>\n  <\/div>\n<\/div><\/div><fieldset id=\"field_72_89\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Routine du matin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_89'><div class='gchoice gchoice_72_89_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.1' type='checkbox'  value='gquiz5418f91d00'  id='choice_72_89_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_1' id='label_72_89_1' class='gform-field-label gform-field-label--type-inline'>Nettoyant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_89_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.2' type='checkbox'  value='gquiz547bb61ae7'  id='choice_72_89_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_2' id='label_72_89_2' class='gform-field-label gform-field-label--type-inline'>S\u00e9rum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_89_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.3' type='checkbox'  value='gquiz5437550243'  id='choice_72_89_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_3' id='label_72_89_3' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me hydratante<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_89_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.4' type='checkbox'  value='gquiz549bbfacdf'  id='choice_72_89_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_4' id='label_72_89_4' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_89_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.5' type='checkbox'  value='gquiz548334619a'  id='choice_72_89_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_5' id='label_72_89_5' class='gform-field-label gform-field-label--type-inline'>Maquillage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_89_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.6' type='checkbox'  value='gquiz548707b427'  id='choice_72_89_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_89_6' id='label_72_89_6' class='gform-field-label gform-field-label--type-inline'>Rien<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_72_90\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden gquiz-field \"  data-field-class=\"gquiz-field\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Routine du soir<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_90'><div class='gchoice gchoice_72_90_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.1' type='checkbox'  value='gquiz5418f91d00'  id='choice_72_90_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_1' id='label_72_90_1' class='gform-field-label gform-field-label--type-inline'>Nettoyant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_90_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.2' type='checkbox'  value='gquiz547bb61ae7'  id='choice_72_90_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_2' id='label_72_90_2' class='gform-field-label gform-field-label--type-inline'>S\u00e9rum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_90_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.3' type='checkbox'  value='gquiz5437550243'  id='choice_72_90_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_3' id='label_72_90_3' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me hydratante<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_90_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.4' type='checkbox'  value='gquiz549bbfacdf'  id='choice_72_90_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_4' id='label_72_90_4' class='gform-field-label gform-field-label--type-inline'>Cr\u00e8me solaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_90_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.5' type='checkbox'  value='gquiz548334619a'  id='choice_72_90_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_5' id='label_72_90_5' class='gform-field-label gform-field-label--type-inline'>Maquillage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_72_90_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_90.6' type='checkbox'  value='gquiz548707b427'  id='choice_72_90_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_90_6' id='label_72_90_6' class='gform-field-label gform-field-label--type-inline'>Rien<\/label>\n\t\t\t\t\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_72_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_22' class='gform_page step-female-10-wrapper' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_22' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_72_93\" 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_below field_validation_below gfield_visibility_hidden\"  > <div class=\"fml-retrieve-image\">\n            <img decoding=\"async\" src=\"https:\/\/fillmed.com\/wp-content\/plugins\/skin-diag-pictures\/fillmed-skin-diag-img-06.webp\" alt=\"Your Image Description\" \/>\n        <\/div><\/div><fieldset id=\"field_72_92\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline button-toggle button_select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class=\"gfield_label gform-field-label\"><h3>Avez-vous d\u00e9j\u00e0 r\u00e9alis\u00e9 des traitements esth\u00e9tiques ou cosm\u00e9tiques ?<\/h3><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_72_92'>\n\t\t\t<div class='gchoice gchoice_72_92_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='gquiz3817674139'  id='choice_72_92_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_92_0' id='label_72_92_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_72_92_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='gquiz92418cbcc4'  id='choice_72_92_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_72_92_1' id='label_72_92_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/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_72_91' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Retour'  \/> <input type='button' id='gform_next_button_72_91' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_72_23' class='gform_page final-submission-form' data-js='page-field-id-91' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_72_23' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_72_96\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >EXPOSOME<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_96'>\n                            \n                            <span id='input_72_96_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.3' id='input_72_96_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_96_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_98\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >SKIN AGEING<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_98'>\n                            \n                            <span id='input_72_98_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_98.3' id='input_72_98_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_98_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_97\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >BEAUTY JOURNEY<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_97'>\n                            \n                            <span id='input_72_97_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_97.3' id='input_72_97_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_97_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_99\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >EXPOSOME label<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_99'>\n                            \n                            <span id='input_72_99_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_99.3' id='input_72_99_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_99_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_100\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >EXPOSOME symbol<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_100'>\n                            \n                            <span id='input_72_100_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_100.3' id='input_72_100_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_100_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_101\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >SKIN AGEING label<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_101'>\n                            \n                            <span id='input_72_101_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_101.3' id='input_72_101_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_101_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_102\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >SKIN AGEING + BEAUTY_JOURNEY initials<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_102'>\n                            \n                            <span id='input_72_102_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_102.3' id='input_72_102_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_102_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><fieldset id=\"field_72_103\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >BEAUTY_JOURNEY label<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_72_103'>\n                            \n                            <span id='input_72_103_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_103.3' id='input_72_103_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_72_103_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><div id=\"field_72_63\" 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_below field_validation_below gfield_visibility_visible\"  ><div class=\"skin-diagnostic-result\">\n  <h2>Diagnostic <span>complet<\/span><\/h2>\n  <h3>Votre pr\u00e9-consultation est pr\u00eate. <\/h3>\n\n  <div class=\"skin-profile-prompt\">\nPour d\u00e9couvrir votre proposition de plan de traitement personnalis\u00e9 par FILLMED, entrez votre adresse e-mail. \nNous vous enverrons votre \u00e9valuation compl\u00e8te de la peau directement dans votre bo\u00eete de r\u00e9ception en un seul clic.\n  <\/div>\n<\/div>\n<\/div><div id=\"field_72_61\" class=\"gfield gfield--type-email gfield--input-type-email 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_72_61'>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_61' id='input_72_61' type='email' value='' class='large'   placeholder='catherine-dupond@gmail.com' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_72_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Untitled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_72_62'><div class='gchoice gchoice_72_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='En soumettant votre adresse e-mail, vous acceptez que vos informations soient utilis\u00e9es \u00e0 des fins de publicit\u00e9 personnalis\u00e9e et d\u2019envoi de newsletters. Pour plus de d\u00e9tails, veuillez consulter notre politique de confidentialit\u00e9.'  id='choice_72_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_72_62_1' id='label_72_62_1' class='gform-field-label gform-field-label--type-inline'>En soumettant votre adresse e-mail, vous acceptez que vos informations soient utilis\u00e9es \u00e0 des fins de publicit\u00e9 personnalis\u00e9e et d\u2019envoi de newsletters. Pour plus de d\u00e9tails, veuillez consulter notre politique de confidentialit\u00e9.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_72' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='submit' id='gform_submit_button_72' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='ENVOYER'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_72' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_72' id='gform_theme_72' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_72' id='gform_style_settings_72' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_72' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='72' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_72' 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