Fill out the form with your personal data

*Personal Data

*Psychiatric Diagnosis

We are interested to know if you have a psychiatric diagnosis. This information helps us provide you with the most appropriate assistance. If you have a diagnosis, select "I have a diagnosis" and fill in the field that will become available.

I don’t have a diagnosisI have a diagnosis

*Consent to receive information

To the extent that you wish to receive invitations to events organized by the Center, communications regarding the promotions offered, new service packages, or other information from the Center, including after the period in which you use our services, via email or phone messaging, please check the box below to express your consent, noting that you can revoke your consent at any time.

I agree to receive information from the CenterI don’t agree to receive information from the Center

*Specific requirements

Since we want to assure you of our good faith, please indicate below any specific requirements regarding the processing of personal data. In this case, select "I have specific requirements" and fill in the field that will become available.

I don’t have specific requirementsI have specific requirements

*How did you find out about PsihoAid?

Google (Internet search)Social Media (Facebook, LinkedIn)Personal recommendation (friend, colleague, family)Other source

*I understand that the information provided through this form is used to complete the Contract for psychological services and is not further processed on the Website.

*I have read and agree with Delivery and Return Policy

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