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Dusan Lazic

Psychothérapeute

* 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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* 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 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

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