Sign up for a 15-minute free consultation
MAGIS Therapies and Mindworks Neurofeedback Center is currently offering 15-minute free online consultations for those who need support and/or would like the opportunity to try psychotherapy/counseling.
CHRISTMAS ADVISORY: We are still accepting consultations throughout the Christmas break but there can be some possible delays with booking appointments due to limited workforce this holiday season. Rest assured that we will do our best to immediately book you as soon as possible.
For questions and/or clarifications, you may contact our team at:
info@magismindworks.com
To help us serve you in the best way possible, please provide the information below.
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)
Or go to the nearest hospital within your vicinity.
All information provided is kept strictly confidential.
* Required
Email address
*
Your email
First Name
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Your answer
Last Name
*
Your answer
Nickname
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Your answer
Age
*
Your answer
Date of birth
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MM
/
DD
/
YYYY
Gender identity
*
Your answer
Civil status
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Single
Married
Divorced
Widowed
Other:
Complete address
*
Your answer
Email address
*
Your answer
Contact number
*
Your answer
Description of the problem or general concern
*
You may be as detailed as you wish. Kindly note as well if you have been diagnosed by a psychiatrist.
Your answer
Are you aware what could be triggering your concern?
*
Please write what triggers your concern and/or when does it happen.
Your answer
How long has this been a problem for you?
*
Please write when did you think your concern has started and how long has it been an issue for you.
Your answer
How often does your concern takes place?
*
If the frequency doesn't match with the choices below, you may be as detailed as you wish by choosing "other".
Daily
Weekly
Monthly
Other:
Have you underwent therapies before?
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Please write the interventions you did in the past.
Your answer
Are you taking any medications for your concern?
*
Please enumerate the medications you are taking as of the moment, if there is any.
Your answer
Is it your first time to seek counseling / psychotherapy?
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Yes
No
What is your preferred language for the consultation?
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English
Filipino
Either english or filipino
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
*
Your answer
Emergency Contact's complete address
*
Your answer
Emergency Contact's contact number/s
*
Your answer
Emergency Contact's relationship to you
*
Your answer
ACKNOWLEDGEMENT
I certify that the information provided in this form is true.
*
Signed and acknowledged
Required
A copy of your responses will be emailed to the address you provided.
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