What is your gender? MaleFemaleOther
What is your age?
What is your relationship status? SingleIn a relationshipMarriedDivorcedWidowedNot Sure
How would you rate your current sleeping habits? Trouble falling asleep or staying asleepSleeping too muchNormal sleep
How would you rate your current financial status? GoodFairPoor
Are you currently experiencing anxiety, grief or depression? YesNo
Had you ever thought to commit suicide? YesNever
Which country are you in?
Your contact number with country code (optional)
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How would you like to communicate with your counselor? ChatEmailVoice CallVideo Call
Anything you would like to tell us
I have made the payment for my first session.