Online Therapy Consent and Payment

First Name (required)

Last Name (required)

Your Email Address(required)

Your Therapist (required)
---Fr. Botrous PhiloposFr. Pishoy WasfyEvelyn de MosLisa HarriottSamir GirguisRuth SmithElaine JahshanKylie Posteraro

Fees (required)

Yes, I have read and agree to the terms listed in the Informed Consent for online counselling.

PS: Please Note that Payment will be done through the "Church of the Virgin Mary and St. Athanasius"