ATENEO BULATAO CENTER APPOINTMENT SIGN-UP FOR PAID PSYCHOLOGICAL SERVICES
Sign in to Google to save your progress. Learn more
Email *
INTRODUCTION TO OUR PSYCHOLOGICAL SERVICES
Good day! Thank you for your interest in the psychological services of the Ateneo Bulatao Center.

This is the sign up sheet for the paid regular psychotherapy services, which refers to our regular paid sessions provided by a licensed psychologist to help address your personal mental health concerns, socio-emotional or psychological functioning. People who have been experiencing acute, chronic, or persistent distress, anxiety, and lower/higher-than-normal level of functioning may benefit from psychotherapy. To set an appointment, kindly fill out the form below.
 
Note: We charge PhP 2,800 for the intake / initial session and PhP 2,500 for each session after / succeeding sessions. Please make sure to check your email regularly after signing up as well for further instructions that will be sent to secure your slot.

FOR COUPLES: We charge PhP 4,500 for the intake / initial session and PhP 4,000 for each session after / succeeding sessions. Each partner must sign up and place a note on their sign up who their partner is. Please put this note on the "Feel free to add more details of your concern" question. Please make sure to check your email regularly after signing up as well for further instructions that will be sent to secure your slot.

Will you be availing discounts?  *
WE'LL REACH OUT TO YOU
Kindly fill out the form and please expect to receive an email from us within the same week (excluding national and university holidays). 

You will also be informed if you are on the waitlist in cases where there is no immediate available therapist who can best support you on your concerns. Rest assured we will accommodate you as soon as possible. 

We understand that you may be needing immediate help and we encourage you to reach out to other centers. You may find other psychological centers in our referral list at http://bit.ly/BPSDirectory
PROCEDURE
1. Please fill out the form below to schedule an appointment for Psychotherapy. NOTE: If you are a current LS Student please secure a referral from the LS Office of Guidance and Counseling BEFORE signing up.

2. Wait for our email regarding the intake process including the documents to be filled out and payment guidelines

3. If you wish to push through with the session, kindly submit the required documents (e.g. 2 IDs, Informed Consent Form, and proof of payment) in the deadline stated by the email. 

4. When the necessary documents are received, you will be lined up for scheduling. Sessions are typically 1 hour long and done through video conference or face-to-face (subjected to therapist's discretion and availability).
DISCLAIMER
Please note that this is NOT A CRISIS LINE. If you are experiencing current distress and are in need of URGENT ATTENTION, please proceed to the emergency room of the hospital nearest you. You can also call the following numbers:

DOH-NCMH Hotline: 0917-899-8727 or 02-7989-8727
In Touch Crisis Line: 0917-800-1123, 0922-893-8944 and 02-8893-7603
Natasha Goulbourn Foundation Hopeline: 0917-558-4673, 0918-873-4673 and 02-8804-4673
INFORMED CONSENT FOR PSYCHOTHERAPY
We would like to assure you that all information disclosed will be handled with utmost confidentiality and privacy in accordance with professional ethical guidelines and data privacy rules.
I have read and understood the information and procedures stated above. *
What is your preferred mode of therapy?
Note: Face-to-face sessions is dependent on the therapist's discretion and availability.
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ateneo de Manila University. Report Abuse