{"id":2422,"date":"2020-06-19T18:42:44","date_gmt":"2020-06-19T18:42:44","guid":{"rendered":"http:\/\/merzaesthetics.m3rzd3v.com\/?page_id=2422"},"modified":"2025-12-04T13:30:45","modified_gmt":"2025-12-04T18:30:45","slug":"forms-consumer","status":"publish","type":"page","link":"https:\/\/merzaesthetics-ca.m3rzd3v.com\/fr\/merzaesthetics\/forms-consumer\/","title":{"rendered":"Forms: Consumer"},"content":{"rendered":"\n<div class=\"wp-block-group container-wrap\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-columns row is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column col-12 col-md-9 col-lg-8 text-center mx-auto is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading col-heading\">Contact Us<\/h3>\n\n\n\n<p>Thank you for reaching out to Merz Aesthetics.<\/p>\n\n\n\n<p>Please select from the following options, so that we may best support you. Please contact Customer Solutions at 1-877-336-4008 to report a product complaint, adverse event, submit a product order, or for order or account-related inquiries.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Consumer and all other individuals<\/h4>\n\n\n<script data-jetpack-boost=\"ignore\" 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 gf-hcp-other_wrapper gform_multi_column_wrapper gform_column_count_2_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_5' >\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5' class='gf-hcp-other gform_multi_column gform_column_count_2' action='\/fr\/wp-json\/wp\/v2\/pages\/2422' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_31\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_31'>X\/Twitter<\/label><div class='ginput_container'><input name='input_31' id='input_5_31' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_31'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_5_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half col-12 col-md-6 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_5_12'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half col-12 col-md-6 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_5_13'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_14\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full col-12 col-md-4 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_5_14'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_5_14' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_5\" class=\"gfield gfield--type-email gfield--input-type-email col-12 col-md-8 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_5_5'>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_5' id='input_5_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_5_24\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full ginput_container_text input field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city ginput_container_address gform-grid-row' id='input_5_24' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_24_1_container' >\n                                        <input type='text' name='input_24.1' id='input_5_24_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                        <label for='input_5_24_1' id='input_5_24_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_24_2_container' >\n                                        <input type='text' name='input_24.2' id='input_5_24_2' value=''    autocomplete=\"address-line2\" aria-required='false'   \/>\n                                        <label for='input_5_24_2' id='input_5_24_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_24_3_container' >\n                                    <input type='text' name='input_24.3' id='input_5_24_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_5_24_3' id='input_5_24_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_24.4' id='input_5_24_4' value=''\/><input type='hidden' class='gform_hidden' name='input_24.6' id='input_5_24_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_5_26\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full 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 gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_state ginput_container_address gform-grid-row' id='input_5_26' >\n                        <span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_26_4_container' >\n                                        <select name='input_26.4' id='input_5_26_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' selected='selected'>Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_5_26_4' id='input_5_26_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_5_26_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/ul><ul class=\"gform_fields top_label form_sublabel_below description_below validation_below column column_2 \"><div id=\"field_5_8\" class=\"gfield gfield--type-select gfield--input-type-select col-12 col-md-6 ginput_container_text input 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_5_8'>Topic<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_5_8' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Choose Your Topic*<\/option><option value='Business Opportunity' >Business Opportunity<\/option><option value='Aesthetics Products' >Aesthetics Products<\/option><option value='Press Request' >Press Request<\/option><option value='Merz as employer' >Merz as employer<\/option><\/select><\/div><\/div><div id=\"field_5_9\" class=\"gfield gfield--type-select gfield--input-type-select col-12 col-md-6 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_5_9'>Product<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_5_9' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Xeomin Aesthetics' >Xeomin Aesthetics<\/option><option value='Radiesse' >RADIESSE<\/option><option value='Belotero' >Belotero<\/option><option value='Ultherapy' >Ultherapy<\/option><option value='Neocutis' >Neocutis<\/option><\/select><\/div><\/div><div id=\"field_5_10\" class=\"gfield gfield--type-textarea gfield--input-type-textarea col-12 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_5_10'>Message<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_5_10' class='textarea medium'   maxlength='1000' placeholder='How can we help?' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_5_30\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_30.1' id='input_5_30_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_30\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_30_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_30.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_30.3' value='2' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_30' tabindex='0'>By completing this form, you consent to Merz Aesthetics Canada Ltd. using your email address and other information you provide to contact you in response to your inquiry. We may disclose the information you submit to select experts within or outside the Merz network for evaluation.<br \/>\n<br \/>\nFor more information about our privacy practices, please read our <a title=\"Privacy Policy\" href=\"https:\/\/merzaesthetics-ca.m3rzd3v.com\/privacy-policy\/\">Privacy Policy<\/a><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_5' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_5' id='gform_theme_5' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_5' id='gform_style_settings_5' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='5' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_5' value='WyJ7XCIzMC4xXCI6XCJkYmIzYTI2YzhjMjc4NWEwMDE0YmFkMmU3N2EyNjQ1MlwiLFwiMzAuMlwiOlwiMDBhYjYxYzYyNTU0YzEwMmYyNjAzZmY3MGU2M2FiYmNcIixcIjMwLjNcIjpcIjM3MzAzMmIxMTE3YThjY2Q4MGIxOTBmY2IyOTZmMmI1XCJ9IiwiMDUxNGMwNmFhNzkzN2U2NWM0ZGEzZmQyZjY1Zjg1MjkiXQ==' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script data-jetpack-boost=\"ignore\" type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 5, 'https:\/\/merzaesthetics-ca.m3rzd3v.com\/app\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_5').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_5');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_5').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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Please select from the following options, so that we may best support you. Please contact Customer Solutions at 1-877-336-4008 to report a product complaint, adverse event, submit a product order, or for order or account-related inquiries. Consumer and all other individuals<\/p>","protected":false},"author":1,"featured_media":0,"parent":8,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"custom-page-category":[],"class_list":["post-2422","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<title>Forms: Consumer - Merz Aesthetics Canada<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.merzaesthetics.ca\/merzaesthetics\/forms-consumer\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms: Consumer - Merz Aesthetics Canada\" \/>\n<meta property=\"og:description\" content=\"Contact Us Thank you for reaching out to Merz Aesthetics. Please select from the following options, so that we may best support you. 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