Counseling Questionnaire
Name *
Your answer
Age *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
City of Residence *
Your answer
I feel anxious most of the time.
I don't know why I cannot achieve the goals I have set.
I feel like I have let people down.
People have rejected me in the past.
I would prefer to meet with a Counselor instead of my family members to assist me with these emotional needs.
What questions do you have about Counseling?
Your answer
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