Free Virtual Clinic Registration Form - powered by ReliveNow
The COVID-19 quarantine has resulted in an increase in anxiety and stress. Amidst the panic, ReliveNow is offering FREE of charge, 15-minute counselling sessions with a mental health expert where you can have a quick chat with them on how to cope up with the current situation.

PLEASE NOTE THE FOLLOWING:
- By filling out the form you are providing us the consent to go ahead providing you counselling and therapy services.
- Each session will last for 15 mins and after that the session will automatically end.
- Please do not book multiple sessions and let others get an opportunity to take help as well.
- Once you fill out the form a session will be booked for you the next day. You will receive an email for confirmation.
- All the information shared will be kept strictly confidential and will be used for communication purposes only.
- Since we have limited slots, please respond to this message with your confirmation. If you do not respond within 2 hours, the slot will be given to those who have confirmed.
Email address *
What time would suit you for you session? Please choose a bracket that you are most comfortable with and a final slot will be emailed to you. *
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