Registration for Counselling @MHM
Hello!

Welcome to The MHM Clinic's Registration Form. We understand that you are looking for a counsellor. Please help us assign you one by answering the following questions.
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Please enter your full name (It will remain confidential) *
What is your email address? *
What is your phone number? (Contactable on WhatsApp) *
Age  *
Gender *
What issues are you facing with your mental health? *
Required
How urgently do you need help? (We cannot promise you will get help at the speed you request but we will surely try) *
How much can you pay per session? You can enter any amount between ₹300 - ₹1200! (You may also let us know if you can't afford to pay. Pro bono clients will have to wait till a counsellor is available. Priority based on first come first serve) *
What quarter of the day works for you for weekly sessions? *
Required
Which day of the week works for you for weekly sessions? *
Required
Type of sessions  *
Do you have any special requests?
Submit
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