Client Intake Form

Thank you for choosing to explore therapy with me. Beginning this journey takes courage, and I’m here to support you every step of the way.

To help me better understand your needs, kindly fill out this form. I will reach out to you shortly after reviewing your responses. You’ll also find more information about my work below.

I’m Nishtha Uniyal, a Counselling Therapist and Art Therapy Practitioner.
I hold a B.A. (Hons.) in Psychology and an M.A. in Clinical Psychology from Amity University, Noida.

I follow an integrative, client-centered approach, tailoring each session to suit your unique experiences and concerns.


📍 Session Modes:

Online sessions: Zoom
In-person sessions: Jasola Vihar, Delhi


🌼 Approach to Therapy

My work is centered on creating a safe, empathetic, and non-judgmental space where you can explore your thoughts, emotions, and experiences at your own pace.



Together, we will work towards:

  • Gaining clarity and insight 
  • Building healthy coping strategies
  • Creating meaningful and lasting change
Appointment Procedure 

Once you submit the form, I will contact you via your preferred mode of communication with further details.

Response Time: Within 48 working hours (subject to availability)


📧 Contact: 7248006064

       Email: nishthauniyal03@gmail.com


Note:

 All the information you share will remain strictly confidential and accessible only to me.

Session Charges Rs. 1000/ Per Session.


Sign in to Google to save your progress. Learn more
Name *
Age *
Email ID *
WhatsApp Number *
Preferred mode Communication *
Educational Qualifications (e.g., MA English)

*

What concerns are you seeking therapy for?

*
Are you looking for:

*
What time suits you best for therapy? (you can select multiple options) 

*
Anything else you want me to keep in mind?

*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report