Seeking a Counselor
All information on this form will be kept strictly confidential to The Blue Dawn's trusted volunteers and will not be shared with anyone else without your explicit consent. We take your privacy very seriously.
I hereby declare that I belong to SC/ST/OBC community (across religions) according to the lists published by central and state governments. [If you are confused about this, you can find the lists on government websites.]
Please tell us your name (or how you'd like us to call you)
Phone number where we can call or message you
Your email address
Are you seeking mental health counseling?
Yes I would like to speak with a counselor
I'm not sure; I'd like to speak with a volunteer about whether counseling is right for me
No I have some other concern
Which mode of counseling/therapy sessions would you prefer
How are you doing right now?
I'm doing fine
I'm okay but would like to speak with someone
I'm not doing well
I'm afraid I might be in immediate danger or may be a danger to myself or others
(optional) Can you describe your situation?
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