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.] *
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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 *
Your location *
Are you seeking mental health counseling?
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Which mode of counseling/therapy sessions would you prefer
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How are you doing right now?
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(optional) Can you describe your situation?
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