Seeking a Counselor

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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.] *

Yes

Required

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?

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

Clear selection

Which mode of counseling/therapy sessions would you prefer

In-person

Telephonic

Skype sessions

Clear selection

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

Clear selection

(optional) Can you describe your situation?

Submit

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