Please fill out this very brief questionnaire to help us have some general background anonymously required to suggest you a suitable online therapist/counselor.

  • For Someone I Know
  • Issues you want to address
  • For Someone I Know Appointment Form

Gender

What’s the gender of the patient?

How old is the patient?

What’s the relationship status of the patient?

Has the patient ever been in therapy or counseling before?

Issues you want to address

What issues are to be addressed through therapy/counselling?

Therapist/counselor Preference

Do you prefer a male or female therapist/counselor?

How would you like us to get back to you?

Email

Mobile/WhatsApp No (With country code if not from Pakistan)

Any other question or comment