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Session Request Form: Madline
Complete the form below to request a virtual session or in-person session in Brussels, Belgium.
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* Indicates required question
First name
*
Your answer
Last name
*
(We respect your confidentiality!)
Your answer
What's your best email address?
*
Your answer
What pronouns are right for you?
*
Your answer
What's your phone number?
*
Your answer
Would you like a virtual (online) session or an in-person session? (In person sessions are in Brussels, Belgium, Europe.
*
Virtual (online)
In-person
When would you like your session to be?
*
(Request a specific date, day, and/or time of day)
Your answer
How long would you like your session to be?
*
60 mins
90 mins
Other:
What are you looking for in a session?
*
Your answer
If it hasn't happened already, the next step is typically to schedule a short conversation with you. When is the best time to schedule this?
E.g. Weekday afternoons, Wednesday at 12pm etc.
Your answer
Is there anything else you'd like Madline to know?
Your answer
How did you hear about us?
Your answer
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