{"id":606,"date":"2015-03-09T21:05:21","date_gmt":"2015-03-10T01:05:21","guid":{"rendered":"https:\/\/staging2.madd.ca\/pages\/?page_id=606"},"modified":"2026-07-29T16:20:53","modified_gmt":"2026-07-29T20:20:53","slug":"sondage-aupres-des-victimessurvivants","status":"publish","type":"page","link":"https:\/\/madd.ca\/pages\/programmes\/services-aux-victimes\/sondage-aupres-des-victimessurvivants\/?lang=fr","title":{"rendered":"Demande d\u2019information pour les victimes et les survivants"},"content":{"rendered":"<p>Les renseignements recueillis dans ce sondage sont transmis directement aux services aux victimes de MADD Canada.<\/p>\n<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-overflow:visible;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" style=\"--awb-bg-size:cover;--awb-margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4111-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4111\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/pages\/wp-json\/wp\/v2\/pages\/606#wpcf7-f4111-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4111\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4111-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p>S\u00e9lectionner votre r\u00e9gion:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-recipient\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"your-recipient\"><option value=\"R\u00e9gion de l\u2019Ouest \u2013 CB, AB, SK, MB, YT, TNO\">R\u00e9gion de l\u2019Ouest \u2013 CB, AB, SK, MB, YT, TNO<\/option><option value=\"R\u00e9gion de l\u2019Ontario\">R\u00e9gion de l\u2019Ontario<\/option><option value=\"R\u00e9gion du Qu\u00e9bec\">R\u00e9gion du Qu\u00e9bec<\/option><option value=\"R\u00e9gion de l\u2019Atlantique \u2013 NB, NE, IPE, TNL\">R\u00e9gion de l\u2019Atlantique \u2013 NB, NE, IPE, TNL<\/option><\/select><\/span>\n<\/p>\n<p>Visitez-vous notre site internet pour la premi\u00e8re fois?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Isthisthefirsttimethatyouarevisitingourwebsite\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"Isthisthefirsttimethatyouarevisitingourwebsite\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"Isthisthefirsttimethatyouarevisitingourwebsite\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Un membre de votre famille a-t-il \u00e9t\u00e9 tu\u00e9 dans une collision impliquant la conduite avec facult\u00e9s affaiblies?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"wassomeonekilledinanimpaired\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"wassomeonekilledinanimpaired\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"wassomeonekilledinanimpaired\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Si oui, quel membre de la famille?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-lose\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Parent\" \/><span class=\"wpcf7-list-item-label\">Parent<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Fils\/Fille\" \/><span class=\"wpcf7-list-item-label\">Fils\/Fille<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Partenaire\/Conjoint\" \/><span class=\"wpcf7-list-item-label\">Partenaire\/Conjoint<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Fr\u00e8re\/S\u0153ur\" \/><span class=\"wpcf7-list-item-label\">Fr\u00e8re\/S\u0153ur<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Grand-parent\" \/><span class=\"wpcf7-list-item-label\">Grand-parent<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Neveu\/ Ni\u00e8ce\" \/><span class=\"wpcf7-list-item-label\">Neveu\/ Ni\u00e8ce<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Tante\/Oncle\" \/><span class=\"wpcf7-list-item-label\">Tante\/Oncle<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-lose[]\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Est-ce que vous ou un membre de votre famille avez subi des blessures dans une collision impliquant la conduite avec facult\u00e9s affaiblies?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-injured\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"J\u2019ai \u00e9t\u00e9 bless\u00e9\" \/><span class=\"wpcf7-list-item-label\">J\u2019ai \u00e9t\u00e9 bless\u00e9<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Parent\" \/><span class=\"wpcf7-list-item-label\">Parent<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Fils\/Fille\" \/><span class=\"wpcf7-list-item-label\">Fils\/Fille<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Partenaire\/Conjoint\" \/><span class=\"wpcf7-list-item-label\">Partenaire\/Conjoint<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Fr\u00e8re\/S\u0153ur\" \/><span class=\"wpcf7-list-item-label\">Fr\u00e8re\/S\u0153ur<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Grand-parent\" \/><span class=\"wpcf7-list-item-label\">Grand-parent<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Tante\/Oncle\" \/><span class=\"wpcf7-list-item-label\">Tante\/Oncle<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Neveu\/ Ni\u00e8ce\" \/><span class=\"wpcf7-list-item-label\">Neveu\/ Ni\u00e8ce<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-injured[]\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Le conducteur fautif a-t-il \u00e9t\u00e9 accus\u00e9 de conduite avec les facult\u00e9s affaiblies?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-charged\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-charged\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-charged\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-charged\" value=\"Je ne sais pas\" \/><span class=\"wpcf7-list-item-label\">Je ne sais pas<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Avez-vous consult\u00e9 un avocat sp\u00e9cialis\u00e9 dans les r\u00e9clamations suite \u00e0 des l\u00e9sions corporelles?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-lawyer\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-lawyer\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-lawyer\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Avez-vous \u00e9t\u00e9 contact\u00e9 par les services aux victimes de votre r\u00e9gion?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-contacted\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-contacted\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-contacted\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Aimeriez-vous recevoir de l\u2019information de MADD Canada sur les sujets qui touchent les victimes et les survivants?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-information\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-information\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-information\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Sur quels sujets aimeriez-vous recevoir de l\u2019information?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-more-info\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"La perte et le deuil\" \/><span class=\"wpcf7-list-item-label\">La perte et le deuil<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Vivre avec des l\u00e9sions corporelles\" \/><span class=\"wpcf7-list-item-label\">Vivre avec des l\u00e9sions corporelles<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Le guide du syst\u00e8me de justice \u00e0 l\u2019intention des victimes\" \/><span class=\"wpcf7-list-item-label\">Le guide du syst\u00e8me de justice \u00e0 l\u2019intention des victimes<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Le guide des lois entourant les r\u00e9clamations en cas de l\u00e9sions corporelles\" \/><span class=\"wpcf7-list-item-label\">Le guide des lois entourant les r\u00e9clamations en cas de l\u00e9sions corporelles<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Les services aux victimes et aux survivants de MADD Canada\" \/><span class=\"wpcf7-list-item-label\">Les services aux victimes et aux survivants de MADD Canada<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Les hommages disponibles pour les victimes et les survivants\" \/><span class=\"wpcf7-list-item-label\">Les hommages disponibles pour les victimes et les survivants<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Un \u00eatre cher conduit avec les facult\u00e9s affaiblies? Faits et cons\u00e9quences.\" \/><span class=\"wpcf7-list-item-label\">Un \u00eatre cher conduit avec les facult\u00e9s affaiblies? Faits et cons\u00e9quences.<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Le sentiment de culpabilit\u00e9 du survivant\" \/><span class=\"wpcf7-list-item-label\">Le sentiment de culpabilit\u00e9 du survivant<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Aider les enfants \u00e0 vivre un deuil ou une perte\" \/><span class=\"wpcf7-list-item-label\">Aider les enfants \u00e0 vivre un deuil ou une perte<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Aider les adolescents \u00e0 vivre un deuil ou une perte\" \/><span class=\"wpcf7-list-item-label\">Aider les adolescents \u00e0 vivre un deuil ou une perte<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-more-info[]\" value=\"Vous avez \u00e9t\u00e9 t\u00e9moin d\u2019une collision impliquant la conduite avec facult\u00e9s affaiblies\" \/><span class=\"wpcf7-list-item-label\">Vous avez \u00e9t\u00e9 t\u00e9moin d\u2019une collision impliquant la conduite avec facult\u00e9s affaiblies<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Commentaires suppl\u00e9mentaires:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-additional\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-additional\"><\/textarea><\/span>\n<\/p>\n<p>Pr\u00e9nom :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span>\n<\/p>\n<p>Nom :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lastname\" \/><\/span>\n<\/p>\n<p>Adresse :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n<\/p>\n<p>Ville :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n<\/p>\n<p>Province:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Province\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Province\"><option value=\"AB\">AB<\/option><option value=\"CB\">CB<\/option><option value=\"MB\">MB<\/option><option value=\"NB\">NB<\/option><option value=\"TNL\">TNL<\/option><option value=\"NE\">NE<\/option><option value=\"ON\">ON<\/option><option value=\"IPE\">IPE<\/option><option value=\"QC\">QC<\/option><option value=\"SK\">SK<\/option><option value=\"YT\">YT<\/option><\/select><\/span>\n<\/p>\n<p>Code postal:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-585\"><input size=\"7\" maxlength=\"7\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"A1A 1A1\" type=\"text\" name=\"text-585\" \/><\/span>\n<\/p>\n<p>Courriel :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n<\/p>\n\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" style=\"--awb-border-size:1px;--awb-border-top-left-radius:0px;--awb-border-top-right-radius:0px;--awb-border-bottom-left-radius:0px;--awb-border-bottom-right-radius:0px;\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div>\n<\/form>\n<\/div>\n\n<p>&nbsp;<\/p>\n<p class=\"x_MsoNormal\"><span lang=\"FR-CA\">Si vous avez besoin de soutien imm\u00e9diat, n\u2019h\u00e9sitez pas \u00e0 communiquer avec le responsable des services aux victimes de votre r\u00e9gion\u00a0:<\/span><\/p>\n<ul type=\"disc\">\n<li>Mackenzie Sorensen, r\u00e9gion de l\u2019Ouest (MB, SK, AB, CB, YT, TNO), 1-800-665-6233 poste 235, <a href=\"mailto:msorensen@madd.ca\">msorensen@madd.ca<\/a><\/li>\n<li>Chlo\u00e9 Pich\u00e9, r\u00e9gions de l\u2019Ontario et du Qu\u00e9bec 1-800-665-6233 poste 237, <a href=\"mailto:cpiche@madd.ca\">cpiche@madd.ca<\/a><\/li>\n<li>Meghann Wetmore, r\u00e9gion de l\u2019Atlantique, 1-800-665-6233, ext 225, <a href=\"mailto:mwetmore@madd.ca\">mwetmore@madd.ca<\/a><\/li>\n<\/ul>\n<div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Les renseignements recueillis dans ce sondage sont transmis directement aux services aux victimes de MADD Canada.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":559,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-606","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/pages\/606","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/comments?post=606"}],"version-history":[{"count":4,"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/pages\/606\/revisions"}],"predecessor-version":[{"id":37241,"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/pages\/606\/revisions\/37241"}],"up":[{"embeddable":true,"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/pages\/559"}],"wp:attachment":[{"href":"https:\/\/madd.ca\/pages\/wp-json\/wp\/v2\/media?parent=606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}