Rotary Club of Jammu Elite
Offers online Covid-19 crisis counselling and mental health intervention service
We are glad to know that you plan to seek counseling during the covid-19 outbreak. In order to utilize the counseling service, please fill the following form. You will be given time based on the availability of the counselor in the time you choose. These are a few questions to get to know you better before the initial counseling sessions, so that we can help you better. However, for us to help you better, you must answer these questions as frankly and truly as possible. Please note that all this information answered in this form will be kept confidential.
Prefer not to say
Present Living With
Most suitable counseling time (Monday-Saturday)
10:00 AM to 01:00PM
02:00 PM to 05:00 PM
Please describe your main concern for which you are seeking counseling for
What are your expectations from the counseling sessions
You need someone to hear your concern
Social isolation issue
Please describe your issue for which you are seeking counseling. State your main concern.
Medical/ Physical Health
Sometimes not well
Consistently not well
Undertaking: I am aware the counseling is online through the verbal-audio medium. I hereby submit that I would not involve in any form of recording of the session or its distribution in any form.
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Terms of Service