Proposed Client Details
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Email *
Mobile Number with Whats App Facility *
Full Name ( as per Valid Identity Card ) *
Gender *
Date of Birth *
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DD
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YYYY
Marital status *
Address
City *
Country *
Consultation Mode *
Required Service from GNCC *
Problem Statement in Brief *
Proposed Date for initial discussion *
MM
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DD
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YYYY
Proposed Time for initial Discussion ( Indian Time ) *
Time
:
Is COVID19 Vaccination is Done (In Case of Personal Meeting ) *
TERMS & CONDITIONS ...................... The Client indemnifies and holds harmless Greeshma Nataraj Counselling Café, counsellors, therapists, interns, coaches, supervisors and any representatives therein. Online and telephone therapy/counselling/coaching is not a replacement for clinical face to face counselling and therefore Greeshma Nataraj Counselling Café. cannot be held responsible for any actions of its clients. Please be aware that Counselling or Psychotherapy Treatments are not a substitute for professional medical care by a qualified doctor or other health care professional. Always check with your doctor if you have any concerns about your condition or treatment. Clients are responsible for assessing the outcome of their treatment.Please note that talking therapies are not intended to replace allopathic and conventional medical treatment and care. Nor are they intended to replace formal diagnosis and treatment by a qualified medical practitioner. Talking therapies may give information or guidance that could bring about positive change and such information or guidance is given for the client to consider/ Although the therapist will be supportive and helpful as possible in all decision making and change processes, any resulting choices and changes made by the client do remain the personal and legal responsibility of the client. *
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