Counseling appointment request form: HAP
Please use this form if you are seeking an appointment for counseling at the Hyderabad Academy of
Psychology so we can help you set up an appointment quickly and easily. Thanks!

COUNSELING INFORMATION: Session fees (one hour duration) range from Rs. 1500/-, Rs. 2000/- or Rs. 3000/- per individual counseling session depending on the counselor you see.
Couples sessions costs Rs. 3000/- to Rs. 4500/- per session of 1.5 hour duration.

You can use this form to request a slot for free counseling via your company's EAP services (if your company has a tie up with HAP) as well.

Please see http://thehap.in/about-us.html for information about available counselors. We try to assign you the right counselor based on the information you shared in this form, so we will share the specific counselors charges with you when we reach out to you to schedule an appointment for counseling.
Email *
WhatsApp Phone number to call to schedule the appointment. Please note that we will not use WhatsApp for any other communication other than to schedule/cancel appointments. If we receive messages via WhatsApp regarding anything else, those messages will not be responded to. By giving your number below, you agree to using WhatsApp to communicate with HAP as per HAP's policy. Thanks. If you do not use WhatsApp, then enter NA below *
If you do not use WhatsApp, kindly share the phone number below where we can contact you for setting up your appointment. If you use whatsapp and have given us the number above already, then you can enter NA below.
Are you seeking free counseling through your company's Employee Assistance Program (EAP) services based on your company's tie up with HAP? *
If YES to the above questions, kindly write the name of your company. If not, just write NA. *
Are you seeking counseling for yourself or someone else? *
If you are seeking counseling for someone else, is that person aware you are seeking counseling for them and are they agreeing to come to counseling of their own free will? *
Name of person seeking counseling *
Age of person seeking counseling *
Gender of person seeking counseling *
Your name if counseling is not for you. If it is for you ,please write NA/Not Applicable *
Your relationship to the person seeing counseling, if counseling is not for you. If it is for you, please write NA/Not applicable * *
What type of counseling are you looking for? *
Please estimate the severity of the problem for which counseling is being sought? *
Currently we are only offering online counseling. The options are via Zoom, Skype - both of these are preferred. Please state your preferences for the platform to be used below. You can tick as many as you are okay with using presently. We do not offer phone only or face to face presently *
Required
Language preferred for counseling. You can check all the boxes that work for you. We primarily offer counseling in English, but are often able to accommodate requests for local languages and we will try our best to do so *
Required
What Days and Times are available for a counseling appointment over the coming week? Please CHECK ALL the slots that work. The more options you provide, the easier it is to schedule you into a slot quickly. Appointments are typically one hour slots for individua counseling and 1.5 hour slots for couples counseling *
None
9 am to 10 am
10 am to 11 am
11 am to 12 pm
12 pm to 1 pm
1pm to 2 pm
2 pm to 3pm
3pm to 4 pm
4 pm to 5pm
5pm to 6 pm
6pm to 7 pm
7 pm to 8pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Do you have a preference for a male or female counselor? *
Who referred you to HAP for counseling? *
What are the difficulties you are experiencing that you seeking counseling for? Please describe the difficulties below. If there are multiple issues you are seeking counseling for, kindly write down all the different areas you need help with. You can be brief as we use the information about the areas you are seeking to work on to assign you to the right counselor. *
Have you ever had counseling before? *
If you have attended counseling in the past, kindly state the reason for not continuing counseling with the same counselor. If you have not attended counseling, write Not applicable
Which of the following are you currently experiencing?
Anything else you think is important that you need us to know before we assign you to a counselor
A copy of your responses will be emailed to the address you provided.
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