Sign up for a 15-minute free consultation
MAGIS Creative Spaces, Inc. is currently offering 15-minute free online consultations for those who need support and/or would like the opportunity to try psychotherapy/counseling or neurofeedback.

To help us serve you in the best way possible, please provide the information below.

For questions and/or clarifications, you may contact our team at:
0927 950 5745 (Mobile/Viber)
hello@magiscreative.net

Please note that this is not a 24/7 hotline.
In case of emergency, or if you think your life or someone else's life is in danger, please call:
DOH-NCMH Hotline:
0917-899-USAP (8727)
0917-989-USAP (8727)


All information provided is kept strictly confidential.
First Name *
Last Name *
Nickname *
Age *
Date of birth *
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DD
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Gender identity *
Civil Status *
Complete address *
Email Address *
Contact Number *
Description of the problem or general concern *
You may be as detailed as you wish
Are you aware of what could be triggering your concern? *
You may be as detailed as you wish
How long has this been a problem for you? *
You may be as detailed as you wish
How often does your concern take place? *
You may be as detailed as you wish
Have you sought therapy before? *
You may be as detailed as you wish
Are you taking any medications for your concern? *
You may be as detailed as you wish
Is it your first time to seek counseling / psychotherapy? *
You may be as detailed as you wish
What is your preferred language for the consultation? *
You may be as detailed as you wish
IN CASE OF EMERGENCY, PLEASE CONTACT:
To support you to the best of our capacity, please include an emergency contact.
Full name of emergency contact *
Emergency Contact's complete address *
Emergency Contact's contact number/s *
Emergency Contact's Relationship to you *
ACKNOWLEDGEMENT
I certify that the information provided in this form is true. *
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