Mann Sarover - Lake of mind

Mann Sarover - Lake of mind

Mann Sarover - Lake of mind

Request you to fill in a few details

Request you to fill in a few details

Request you to fill in a few details

What is your full name?

What is your full name?

What is your full name?

Please state gender and pronouns?

Please state gender and pronouns?

Please state gender and pronouns?

Please state your date of birth?

Please state your date of birth?

Please state your date of birth?

Where are you currently based?

Where are you currently based?

Where are you currently based?

Please state your contact number? (Available on WhatsApp)

Please state your contact number? (Available on WhatsApp)

Please state your contact number? (Available on WhatsApp)

Please share what brings you to therapy, briefly?

Please share what brings you to therapy, briefly?

Please share what brings you to therapy, briefly?

How long have you been facing these concerns?

How long have you been facing these concerns?

How long have you been facing these concerns?

What do you do to cope with these concerns?

What do you do to cope with these concerns?

What do you do to cope with these concerns?

How much do your concerns affect your daily routine?

How much do your concerns affect your daily routine?

How much do your concerns affect your daily routine?

Have you taken therapy before?

Have you taken therapy before?

Have you taken therapy before?

Have you ever had suicidal ideations, thoughts, or attempts, that may be ongoing currently or in the past? Have you ever engaged in self-harm behaviours?

Have you ever had suicidal ideations, thoughts, or attempts, that may be ongoing currently or in the past? Have you ever engaged in self-harm behaviours?

Have you ever had suicidal ideations, thoughts, or attempts, that may be ongoing currently or in the past? Have you ever engaged in self-harm behaviours?

Have you tried anything in order to feel better?

Have you tried anything in order to feel better?

Have you tried anything in order to feel better?

What are your goals and expectations from therapy?

What are your goals and expectations from therapy?

What are your goals and expectations from therapy?

Safety Point of Contact - someone who's an adult, whom you trust & can physically reach you in case of an emergency. Please give a name, number & their relationship with you.

Safety Point of Contact - someone who's an adult, whom you trust & can physically reach you in case of an emergency. Please give a name, number & their relationship with you.

Safety Point of Contact - someone who's an adult, whom you trust & can physically reach you in case of an emergency. Please give a name, number & their relationship with you.

I have understood everything that is stated in the Values Terms & Condition and agree to the terms and conditions. I am voluntarily agreeing to receive mental health services at Mann Sarover and abide by its policies.

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