Contact Information

Thank you for taking this important step towards your mental health with The Secret Ingredient. Please fill in the details below to help us understand your needs better. Once we have this information, we can match you with a therapist who will be the best fit to walk alongside you in your personal journey.

We offer online as well as in-person sessions at our office in Kothrud. Please find the charges below:

Session charges for consultation with Ms. Trupti Bobade, Ms. Nimisha Katare or Mr. Abhishek Bhave:

Individual Therapy
First Session: ₹ 1800/-* Duration: 60 minutes
Follow Up Session: ₹1500/-* Duration: 50 minutes 

Session charges for consultation with Ms. Mugdha Shivapurkar

Individual Therapy
First Session: ₹ 2300/-* Duration: 60 minutes
Follow Up Session: ₹2100/-* Duration: 50 minutes 

*Charges inclusive of taxes.

For more information about our terms of confidentiality, please contact us on +91 9921734200 between 9 am to 6 pm, Monday to Saturday, or visit our website www.tsimentalhealth.com  
Sign in to Google to save your progress. Learn more
Name *
Age *
Personal Pronouns
Email *
Address *
Phone number *
Please share 2 Emergency Contacts in order of preference (Full name and number of a family member/ someone who stays in the same city/ someone who will be able to reach out to you/ access you immediately) *
Languages you are comfortable with? *
Required
Primary Area of Concern *
Required
I'm looking for .. *
Please select your preferred Mental Health Practitioner(MHP) from the dropdown list below. (While we will make every effort to assign you to your chosen MHP, please note that MHP availability may vary. Therefore, we cannot guarantee that your preferred MHP will be available for your sessions.)
I am currently going/ have been to a psychiatrist. *
If yes, please specify the details (when was the last time you visited, if there is a diagnosis, any other relevant details)  *If no, please write NA.* *
Are you currently under any psychiatric medication? *
I’m looking to start therapy for ... *
If Others, please specify your relation to the client.
What format would you prefer the sessions to be in? *
Required
Please mention 2-3 days and time slots when you would like to schedule sessions. This helps us in assigning a counselor who will be available on those days. *
Required
Please fill in any more information that you think is relevant for the counselor to know.
How did you hear about us? *
Required
I’m willing to start therapy sessions at The Secret Ingredient and abide by the guidelines of confidentiality that The Secret Ingredient follows. *
Required
Thank you for filling out the form. Please note that we are not an emergency helpline/ crisis center. In case this is a crisis we request you to please seek help with an emergency helpline *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of tsimentalhealth.com.

Does this form look suspicious? Report

Google Forms