Beyond Superficial by Vaishnavi Madarkal
This form is developed to book Online Counseling Services with Ms. Vaishnavi Madarkal (Psychologist/Psychotherapist). Once this form is submitted, you can expect to be contacted through the mode of contact you have chosen in the form within 24 hours. Please do read the Disclaimers provided below thoroughly. Thank You !
Preferred type of Counselling?
1. You hereby consent to recording of the audio for call sessions & maintaining records for chat sessions if the Therapist wishes to.. Complete privacy & confidentiality is promised by the Therapist. All ethical rules shall be followed by the Therapist. However, the Psychologist has the right to share this information for the following reasons: 1) Court Order 2) Serious life threat or abuse/Domestic Violence to either client or someone else 3) In case of client being an adolescent.
2. Trying to demean or cause harm to the reputation of the Counsellor on social media or in any other form will be considered offense/defamation & strict legal action will be taken.
3. If you have a crisis, are in need of suicide prevention or deem yourself or others to be in danger of any kind, kindly contact a medical doctor for Counseling.
4. The Therapist and/or Beyond Superficial is not responsible for any adverse step or actions taken by client.
5. Please do not expect results from one session, appropriate steps/therapies will be suggested post preliminary assessment.
6. As a Consulting Psychotherapist, the Therapist is not authorised to provide any report or medico-legal certificate.
7. If you are an adult (18+) & the Therapist finds you to NOT have any extreme Psychotic or Neurotic issues, extreme Suicidal Tendencies, been a Domestic Violence and/or Child abuse victim - then she is not liable to inform any support group/guardian/hostel management/parents. As an adult it is solely your responsibility if you seek support.
8. Any misuse of phone number, harrassment, abuse, blackmails, calling out of stipulated session hours or any such indecent/unethical/irresponsible behaviour will be subjected to strict legal action.
9. Counselling & Therapies are collaborative & results depend on Client's willingness & compliance with tasks & homeworks given. You acknowledge that there is no guarantee of 100% results.
10. It is mandatory for the client to adhere to the decided time slot & stick to stipulated session time of typically one hour. Demanding any more time post one hour will be considered as another session and will be charged accordingly.
11. Prior booking is mandatory. Any changes with regards to time slot is left to Therapist's discretion to accept or not.
12. Amount paid is non-refundable in case of cancellation of session or package from the client.
13. The Therapists holds authority to shift session slots according to convenience.
14. A person with extreme suicidal ideations shall not be counselled and is expected to contact a Psychiatrist in that case.
15. Therapist's working hours start from 11 A.M to 7 P.M only. Any calls after that against the Therapist's permission shall be considered harassment.
16. You hereby acknowledge & indemnify Beyond Superficial & Therapist harmless.
Contact / WhatsApp Number
I Agree to the terms and conditions
A copy of your responses will be emailed to the address you provided.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service