Therapy Intake - Kritika Mehta
Hello there! Thank you for your interest in seeking therapy with me.

I am currently at full capacity and unable to accept new clients.

I will revert when a slot becomes available, which could be at least 3 months. The sessions will only be online. Kindly fill up this form as it would allow me to understand a couple of things before we get started. I will get in touch with you shortly after you fill up this form. You can email me at Kritika.m1@gmail.com if there is any other information I can help you with. Thanks!

The information you share with me here and in our sessions is a 100% CONFIDENTIAL.
Sign in to Google to save your progress. Learn more
Email *
Name *
Who are you seeking therapy for? *
Name of the client if not seeking for self
Age of the client *
Contact number *
Current city of residence *
Presenting concerns / reason you’re seeking therapy *
Please mention who you'd prefer to work with *
Are you comfortable with online sessions? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms