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Adrien
2020-09-25T10:41:07+00:00
Consult
a specialist
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Contact Person
Name
First Name
Telephone Number
Mobile Phone
Email Address
Region of Residence
Centre/East/South
North
West
Appointment for whom?
I am making an appointment for:
Myself
Someone else
If you are making an appointment for someone else but you:
Name
First Name
Relationship
Son
Daughter
Other
Details of the patient / client:
Sex
Male
Female
Other
Age
Preferred Language
French
English
Can also converse in
French
English
Other
If the patient is a child/adolescent:
Name of educational institution
Grade/Year
Please indicate the specialty
CHILD & ADOLESCENT PSYCHOLOGY
PSYCHOTHERAPY
SPEECH & LANGUAGE THERAPY
OCCUPATIONAL THERAPY
PSYCHOMOTOR THERAPY
CAREER COUNSELLING
Conclusion
In a few words, why do you wish to consult a therapist?
What are the key elements that have alerted you or others?
Since when do they occur?
Would you like to meet a specific therapist?
Cécile Ogereau
Cindy Ramphul
Elise Koenig
Fiona Kau (remote therapy)
Laetitia Julien
Louise Espitalier-Noël
Nasrine Faucheux
Morgane Loquy
Murielle Quevauvilliers
Vincent Mandrou
Any
SHOW SUMMARY
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