<div class="contact-register">
<div class="contact-register-header">
<p>Enter here your</p>
<h4>Appointment request</h4>
<span class="arrow">&nbsp;</span>
</div>
<div class="contact-register-content">
<p>[text* your-name placeholder "Name"]</p>
<p>[tel* phone placeholder "Phone"] </p>
<p>[email* your-email placeholder "EMAIL"] </p>
Choose your sextherapists of preference
</p>[checkbox selection-sexologue "Frank" "Catalina" "Claudia" "Saliha"] </p>
What are your availabilities?
</p>[checkbox selection-dispo "Morning" "Afternoon" "Evening"] </p>
Which format do you want therapy?
</p>[checkbox selection-format "Face to Face" "Webcam" "No preference"] </p>
What type of therapy do you seek?
</p>[select* your-therapy include_blank "Individual psychotherapy" "Couples therapy" "Unsure"]</p>
<p>[textarea* your-message placeholder "Reason for consultation"]</p>
[recaptcha]
</div>
<p>[submit "Send"]</p>
</div>
1
A new registration from [your-name]
[your-name] <info@lesexologue.ca>
sexologue.f.renaud@gmail.com
From: [your-name] <[your-email]>

Phone: [phone]

Sextherapist: [selection-sexologue]

Availabilities: [selection-dispo]

Type of therapy: [your-therapy]

Format: [selection-format]

Message:
[your-message]

--
This e-mail was sent from a HOME contact form on info@lesexologue.ca
Reply-To: [your-email]



1
We have received your email!
Sexcoupletherapy.com  <info@lesexologue.ca>
[your-email]
We have received your message and will get back to you. 

The reception is open from 9am to 5pm from Monday to Friday.

We do however offer availabilities with our therapists from Monday to Friday from 9am to 8:30pm.

Thank you for trusting us. 


-----------------------------------------

Message body:
[your-message]

------------------------
This email was sent by our homepage contact form on our website sexcoupletherapy.com
reply-to: info@lesexologue.ca



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