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Get-Started For Individual
Please answer a few question for us, to connect you with the right therapist.
Get-Started For Individual
Name
*
Email
*
Phone
*
How old are you ?
*
Upto 18 years
18 years - 25 years
25 years - 40 years
Above 40 years
How do you identify ?
*
Male
Female
Prefer not to say
Other
What is your current employment status?
*
Unemployed
IT
Entrepreneur
Healthcare
Student
Entertainment
Finance
Education
Legal
Marketing
How have you been feeling recently?
*
Sad
Happy
Nervous
Angry
Anxious
Lonely
Ashamed
Guilty
Unsatisfied
Unproductive
What are your reasons for seeking therapy ?
*
Experiencing depressive feelings
Feeling anxious/ overwhelmed
Feeling irritated
Issues with exploring my identity
Grief
Trauma
Low self-esteem/low self confidence
Personality development
Self awareness
How long have you been feeling like this?
*
2 weeks
2 weeks- 2 months
2 months- 6 months
6 months- 1 year
1 year- 3 years
3 years- 5 years
More than 5 years
Have you suffered from any chronic illnesses or had any major surgeries?
*
Yes
No
Have you ever experienced suicidal thoughts?
Yes
No
Do you have any therapist preferences ?
*
Clinical therapist
Counselling therapist
Specific Language
No preference
What are your expectations from your therapist
*
Empathetic towards my concerns
Explores my past experiences
Help one build goals
Helps me practise self-reflection
Gives home-work
Motivates me to take up challenges
Check-in with me
Others
If you are human, leave this field blank.
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Dream Analysis Download Brouchure
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Counselling Psychology Download Brouchure
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