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.] *
Required
Please tell us your name (or how you'd like us to call you)
Your answer
Phone number where we can call or message you
Your answer
Your email address *
Your answer
Your location *
Your answer
Are you seeking mental health counseling?
Which mode of counseling/therapy sessions would you prefer
How are you doing right now?
(optional) Can you describe your situation?
Your answer
We also have a WhatsApp support group, in case if you are in search of a safe space. Let us know if you want to be added.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.