First of all, what's your name? *

First name

Last name

Would you like us to contact you by e-mail and/or telephone? *

We won't share your information with anyone, we promise!

yes

no

Phone *

Country

(###)

###

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Ideally, where would you like us to meet for our First Individual Session and any subsequent Sessions? *

In Paris, at Cabinet Médical de l'Étoile

By videoconference, on Zoom