2. What Brings You Here?

3. How Have You Been Feeling Recently?

4. How Long Have You Been Feeling This Way?

5. Therapy History

Have you spoken to a therapist or counsellor before?

6. What Are You Hoping For From Therapy?

7. What Would Help You Feel Comfortable?

What kind of sessions would you prefer?

8. Practical Details

Preferred session format:

9. Safety Check (Important)

Are you currently feeling unsafe or having thoughts about harming yourself? )

If yes: Please tell a trusted adult (parent, guardian, teacher) or reach out to local emergency services or a helpline. This form is not monitored for emergencies.

10. Final Question

How did u hear about us?

11. Consent