Queertherapie

Contact Us

1. First name or preferred name

Indicate the first name or name by which you wish to be addressed, the one that suits you, whether or not it appears on your official documents.

2. Pronouns

Indicate your pronouns if you wish (e.g., she / he / they / you).
If you are unsure, or if the question does not yet resonate with you, leave this field blank.

3. Date of Birth

This information allows me to tailor the support to your life journey.

4. Email address

I will contact you primarily by email to confirm the appointment and provide you with practical information.

5. Phone number

Only if you wish to be contacted by phone or SMS. Please indicate your preference below.

6. Availability

Indicate the days and time slots when you are generally available for a 45-minute session.
Example: Monday and Wednesday evenings, Friday afternoon.

7. Preferred communication platform

The sessions take place entirely via video conference. Choose the application you are most comfortable with:

If you have a preference for communication between sessions (email, SMS, messaging apps, etc.), you can also specify it here.

8. What you wish to share about yourself

This space is open. You can share whatever you feel is important for me to understand who you are: your relationship with gender, sexuality, your body, your history, and your community, or any other element you deem relevant.

There is nothing to prove, nothing to legitimize. Share what feels right to you, at your own pace..

9. Reason for the request

Describe, in your own words, what motivates you to seek support at this time.
It could be a specific situation, a question you are grappling with, a difficult period, or simply a desire to work on yourself.

A few lines are enough; there is no need to explain everything right now..

10. Consent

Please read carefully and check each box before submitting the form.

10a. Privacy and data processing

They are used solely for the preparation and monitoring of the therapeutic support process and will never be shared with third parties without my explicit consent.

The collected data is stored securely, in accordance with applicable legal obligations (GDPR). You may request access to, modification of, or deletion of your data at any time.

10b. Framework and cancellation policy

I understand that:

The sessions last 45 minutes and start at the agreed time;
in case of a delay of more than 15 minutes, The session is considered cancelled and remains payable;
any cancellation made less than 48 business hours remains due before the appointment;
Payment is made before each session, by bank transfer.

10c. Solidarity pricing

I understand that the rates are adjusted based on my financial means, and that this approach aims to make the support accessible to as many people as possible.

By submitting this form, you are taking the first step toward a space that is truly yours.
I will contact you as soon as possible to arrange an initial meeting.