Online TelePsychiatry Platform

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Appointment Form

Before filling in the requirement form, please test your computer to see if it is compatible with Telepsychiatry. If you have completed all the tests successfully, it means your computer is compatible and you can ask for an appointment.

Applicant's personal details:
Name :
Surname:
E-mail Address:
Phone :	(i.e. : +90 216 1234567)

Client's personal details:
Name Surname :
Gender :
Date of birth :	/ /
City/country of residence:
The method of payment preferred:
Receipt Address:.

Online TelePsychiatry Platform

Appointment Form

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