ASADS Initial Contact Form

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ASADS Initial Contact Form

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* Indicates required question

Full name *

Your answer

Your phone number (Whatsapp number) *

Your answer

Age *

18-25

26-35

36-45

45-60

City you live in *

Your answer

Nationality *

Your answer

Which of these apply to you *

I need someone to talk to

I'm having problems with my relationship

I'm LGBT and need to talk to someone who is open minded

I'm having suicidal thoughts

I lost my job

I lost someone dear to me

Next of Kin Contact *

Your answer

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