CONTACT FORM & APPOINTMENT BOOKING

There is no need to describe your story or the difficult events you are going through in detail.

A few lines are enough to help me understand your current request.

If we agree on an initial meeting, we will take the time to explore your situation together at your own pace.

This form is not suitable for situations requiring immediate assistance.

In case of immediate danger, suicidal thoughts or acute crisis, contact 15, 112 or 3114.

First and last name*

Address*

E-mail*

Phone*

What is your request?

I would like to schedule an initial appointment.

I would like to obtain some information before making an appointment.

I would like to be contacted by phone.

I am a healthcare professional or partner.

Other

In a few lines, could you please clarify your request?

This request concerns:

Myself

My child (under 12 years old)

My teenager

My couple

A close friend

Which do you prefer:

Cabinet

Teleconsultation

Indifferent

How would you like to be contacted?

Phone

Mail

Indifferent

I agree that the information submitted via this form will only be used to allow contact in connection with my request.

Tel. 07.81.43.47.06

Contact & appointment →

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