Contact us

Name *

First Name

Last Name

Terms of Use *

By submitting this form, I understand that Dr. Seguin (Seguin Psychotherapy) can not guarantee that the information contained in the form will remain confidential. Even though Dr. Seguin may utilize state of the art encryption methods, firewalls, and backup systems to help secure our communications, there is a risk that the electronic communication may be compromised unsecure and/or accessed by an unintended 3rd party.

Yes, I have read and understand the above risks and want to submit the form.