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Select your appointment - Tatiana Kokkori-Komninos

* Addresses :

* Language:

* Type of appointment:

Adult

23 years and above

(45 minutes)

Child

0 - 4 years

(45 minutes)

Child

5 - 8 years

(45 minutes)

Child

9 - 12 years

(45 minutes)

Adolescent

13 - 16 years

(45 minutes)

Adolescent

17 - 19 years

(45 minutes)

Young adult

20 - 22 years

(45 minutes)

Young senior

60 - 69 years

(45 minutes)

Senior

70 years and above

(45 minutes)

Para

(60 minut)

* Place of consultation :

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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

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* First name:

Name:

First name:

Name:

First name:

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

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KBC/CBC

Belfius

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