<div class="row">
<div class="col-md-9">
<p>[text* your-name placeholder "FULL NAME"] </p>
</div>
</div>

<div class="row">
<div class="col-md-9">
<p>[email* your-email placeholder "EMAIL"] </p>
</div>
</div>

<div class="row">
<div class="col-md-9">
<p>[tel* phone placeholder "PHONE"] </p>
</div>
</div>

Choose your preferred sextherapists or sexologist (more than one choice is possible)
<div class="row">
<div class="col-md-9">
</p>[checkbox selection-sexologue "Frank" "Catalina" "Claudia" "Saliha" "Gabriel-le"] </p>
</div>
</div>

What are your availabilities?
<div class="row">
<div class="col-md-9">
</p>[checkbox selection-dispo "Morning" "Afternoon" "Evening"] </p>
</div>
</div>

What type of consultation do you seek?
<div class="row">
<div class="col-md-9">
</p>[select* your-therapy include_blank "Individual psychotherapy" "Couple therapy" "Individual or couples Counseling" "Unsure"]</p>
</div>
</div>

Which format do you want therapy?
<div class="row">
<div class="col-md-9">
</p>[checkbox selection-format "Face to face" "Webcam" "No preference"] </p>
</div>
</div>

<div class="row">
<div class="col-md-9">
<p>[textarea your-message placeholder "Reasons for consultation"] </p>
</div>
<div class="col-md-3">
<p>[submit "Send"]</p>
</div>
</div>
[recaptcha]
1
A new message from [your-name]
[your-name] <info@lesexologue.ca>
sexologue.f.renaud@gmail.com
From: [your-name] <[your-email]>

Phone: [phone]

Sextherapist: [selection-sexologue]

Type of therapy: [your-therapy]

Availabilities: [selection-dispo]

Format: [selection-format]

Message Body:
[your-message]

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



1
We have received your email!
Le sexologue.ca  <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 contact form on our website sexcoupletherapy.com
reply-to: info@lesexologue.ca



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