MANI Initial Contact Form
Hello, will you love to chat with one of our in-house volunteer counsellors? Please do fill the form below and we'll be in touch as soon as we can.

The counseling service we offer is FREE, our counselors aren't therapists but volunteers with experience in the mental health sector, who are trained to listen to and support you. Our services serve to deescalate, counsel and when necessary, refer you to specialist facilities. Your counsellor will work with you to provide psychological first aid and might refer you to other mental health professionals for further evaluation and treatment if needed. 
(NOTE: if you are referred for such services from mental health professionals, the service is PAID and this fee is determined by the service provider)

Our FREE counselling sessions are virtual and you have access to TWO SESSIONS which span across TWO WEEKS. These virtual sessions are via WhatsApp. You will be contacted by a counsellor within 7days of filling this form. When a counsellor reaches out to you, you will both agree on a schedule for your sessions. Kindly ensure to respond to your counselor within 24 to 48 hours of contact. 

Kindly stay committed to schedule and do well to inform your counselor if for any reason you need a change in schedule. 

Please note, if you do not stay committed to your session, your counselor will TERMINATE your session, and you will have to refill the form to get assigned another counselor.

Also, at the end of your sessions, the counsellor will send you a feedback form. Kindly do well to fill this form as this helps us collate helpful information for improvement in the services that we offer.

If your experience with the counsellor assigned to you does not go as well as you would have hoped, kindly send a mail to crisis@mentallyaware.org, we will assign you to a different counselor.

Filling out this form means you have read the above information guiding our services and you agree to continue.

Thank you.
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Email *
Name (This can be your nick name or an Alias) *
WhatsApp Active Phone number *
If you are not on whatsapp, kindly drop your active phone number below *
Next Of Kin Contact Number *
Do you consider yourself: *
Are you LGBTQ? (This is to help us assign you to an appropriate counsellor) *
Country of residence (Kindly click on other an indicate your country of residence) *
State of residence (Kindly click on other if  not in Nigeria) *
Kindly select your age range *
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