Welcome to Mentality Conclusion

Please complete the form provided to schedule a session with me. Your detailed responses will assist me in determining if I am the best-fit therapist for your needs. Rest assured, confidentiality is paramount, and any information shared during sessions or in this form will remain strictly confidential. Your privacy is respected, and disclosures will only occur with your explicit written consent, except in situations where there is a risk of harm to yourself or others, or as mandated by law.

Completion: After submitting the form, we will carefully review your responses and promptly contact you to arrange your initial counseling session. Should you have any concerns or queries, please do not hesitate to reach out to us directly. Our goal is to provide you with the best possible support and assistance. We recognize the sensitivity of sharing personal information and assure you that your privacy is our top priority. Rest assured, all details shared via this form will be handled with the utmost confidentiality and in compliance with relevant data protection regulations.

Next steps:Complete the intake form, and I’ll review it to determine if I can assist. If so, I’ll give a free 15-minute Discovery call to understand each other better and decide on potential counseling sessions. If we decide to proceed, I’ll share details, including pricing and session duration, through a consent form.

Name *

First

Last

Email *

Contact information (phone number for text or whatsapp) *

Instagram ID *

I'll reach out to you via Instagram. Let's connect and stay in touch through direct messages or comments. Looking forward to engaging with you on the platform soon!

Gender *

• Male
• Female
• Other

Age *

Languages in which you are most comfortable? *

• Hindi
• English

City/Country *

Areas of concern *

• Low confidence
• Lack of motivation
• Changes in mood
• Depressive thoughts
• Behavioural issues (anger,frustration,concentration,phobia,hyperactivity)
• Relationship issues
• Negative thoughts
• Any significant life changes (loss of loved one ,job,etc)
• Others (fill bellow)

Others Issue

Have you ever had any form of counseling or therapy before? *

Short description of the issue that you want to opt counselling session ? Feel free to write what are you facing? [ In Hindi, English, Hinglish ] *

What would you like to achieve form therapy? *

Employement Status *StudentWorking ProfessionalHome Maker

What are Your Preferred Timings for Therapy Session (Working Hours: IST 10 AM to 7 PM) *

Do you take any medicine prescribed by a psychiatrist for mental illness? *

Accepting *

• Yes, I accept the following T&C.

This is a paid service. Kindly note that all payments processed through our platform are non-refundable, regardless of the circumstances. We appreciate your understanding and cooperation in this matter. Rest assured, we strive to provide the best possible service and support to ensure your satisfaction. Should you have any concerns or inquiries regarding payments or our services, please do not hesitate to reach out to our customer support team for assistance. Thank you for choosing our platform.

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