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Select your appointment - Christelle Lapierre Ligue

* Addresses :

* Language:

* Type of appointment:

adulte (60 minutes)

Enfant 0 - 4 ans (50 minutes)

Enfant 5 - 8 ans (50 minutes)

Enfant 9 - 12 ans (50 minutes)

Adolescent 13 - 16 ans (50 minutes)

Adolescent 17 ans et plus (50 minutes)

Couple (50 minutes)

Famille (50 minutes)

Hypnose (55 minutes)

Coaching (50 minutes)

Première ligne - Adulte 15 ans et + (50 minutes)

Première ligne - Enfant / adolescent 0 - 23 ans (50 minutes)

Bilan / Testing (50 minutes)

* Place of consultation :

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* Civility

* Name:

* First name:

* Last name:

* First Name:

* Child's civility:

* Date of birth:

* First name partner:

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* First name:

Name:

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Name:

First name:

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I certify that the data provided are correct and I agree to notify the psychologist at the latest 48 hours before the appointment if I will not be present. Otherwise the consultation will be due.

Bancontact

KBC/CBC

Belfius

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