Personal Information


Male     Female
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What kind of therapy are you interested in?

 Current Mental Health Concerns

What are your primary reasons for seeking therapy?
Please select at least one primary reason!

 Therapy Preferences

Preferred mode of therapy
  • Video Call

    Video Call

  • Audio Call

    Audio Call

  • Chat Session

    Chat Session

Preferred time for sessions
Frequency of sessions

Mental Health History

Have you previously attended therapy
Are you currently taking any medication for mental health
Do you have any history of mental health diagnoses

Lifestyle and Support System

How would you describe your current lifestyle?
Do you have a support system in place (family, friends, etc.)?
How often do you exercise?
Do you have any hobbies or activities that help you relax?

Goals and Expectations

What do you hope to achieve through therapy ?
Any specific goals you would like to focus on during the sessions ?
What are your expectations from the therapist? ?

Additional Information

Is there anything else you would like to share that might help us match you with the best therapist for your needs

Select Session