Intake Form
Greetings!
Thank you for reaching out to me for therapy. Reaching out for help is an act of bravery and it can be challenging to find the practitioner who is the right fit for you, so I’m glad you’re taking this step!
Please fill in the details as requested in the form. The aim of this form is to collect preliminary information about you, help me understand your concerns as well as to redirect you if your needs are greater than what I have to offer. Please read the questions carefully before answering them. All information shared via the form will remain confidential.
All sessions are scheduled by prior appointments only. Once I receive the responses from the form I will reach out to you via email/ whatsapp within 48 hours. Fee Reduction: I see a limited number of clients because of the nature of therapy work itself and so that everyone who chooses to work with me receives my full time and attention. Therefore, I am only able to offer a limited number of slots at reduced session fees to those experiencing financial hardships. Please email me wholistic.connect@gmail.com if you wold like to be accommodated at a lower fee slot. If I am unable to accommodate your financial situation, I will try to provide you with referrals. Please note: I am currently working with only clients above 18+ years. Ps: Offline session are restricted to Panjim, Goa. Please get in touch for further details.