Request a free session with Dr. Kassim

I understand that my request for a free session will be evaluated by Dr. Kassim's team. The request may or may not be approved depending on the information on this form. Dr. Kassim's team reserves the right to approve or decline this request without assigning any reason. *

If approved, I understand that Dr. Kassim's team will reach out to me with potential scheduling options*

I agree to the terms and conditions*