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Summary

Select your appointment - Borana Taraj

Gestalt-thérapeute

* Addresses :

* Language:

* Type of appointment:

Adult

23 years and above

(60 min)

Young adult

20 - 22 years

(60 min)

Young senior

60 - 69 years

(60 min)

Senior

70 years and above

(60 min)

* Place of consultation :

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Mon	Tue	Wed	Thu	Fri	Sat	Sun

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Please fill in the following box. You will receive a code (via e-mail or SMS) which you will need to copy into this box to continue.

If you are unable to confirm your email address or mobile phone number, the online appointment procedure will not be able to continue.

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* Civility

* Name:

* First name:

* Last name:

* First Name:

* Child's civility:

* Date of birth:

* First name partner:

* Name partner:

family composition

* Name:

* First name:

Name:

First name:

Name:

First name:

* E-mail:

* Mobile:

* Country: Please choose a country.

* Postal code:

* City:

* Address:

I accept the Terms and Conditions

I certify that the information provided is accurate and I agree to inform the Logidesk service at least 48 hours before the appointment if I am unable to attend. Otherwise, the consultation fee will still be due.

Bancontact

KBC/CBC

Belfius

You will be redirected to Bancontact after clicking on pay now.

You will be redirected to KBC/CBC after clicking on “Pay now

You will be redirected to Belfius after clicking on pay now.

Details

Service:

Date:

Duration:

Total: €0.00

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