Psychebabble Client Form
Hello, it is so good to see you reaching out for help, it takes courage and we salute you.
Few things to note:
-This free counseling is conducted strictly via whatsapp.
- You get access to 5 free sessions with your counselor. 
- When a counselor reaches out to you and no response within 12 hours, that session will be terminated.
- If the above happens, feel free to reapply.
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone number (Whats app). Please include country code *
Age *
What challenge can we help you with? *
Gender *
Location (if in Nigeria please indicate State) *
Emergency contact - NAME (Someone we can reach out to if we are unable to reach you in an emergency) *
Emergency contact NUMBER - Someone we can reach out to if we are unable to reach you in an emergency. *
How did you hear about Psychebabble Foundation? *
Returning Client? Would you like to speak with your old counselor?  Please type their name.
Disclaimer(Please read carefully)
Thank you for filling this form, One of our volunteer counselors will be in contact with you soon (via WHATSAPP CHAT STRICTLY).

We offer free psychological first aid & counseling and when necessary, refer you to specialist. Our Counselors are not therapists but volunteers with experience in medical/health sector who are trained to listen and support you.

If your sessions didn't go as well as you hoped, please do us a favour and send a mail to

Please note: You shouldn't give out or share the contact of the counselor assigned to you.
Also note: Upon contact after 24 hours without response from you, your counselor can terminate your sessions. If these happen, you can reapply to speak to a counselor.

Please be patient with us as we are dealing with an influx of cases and will assign you to a counselor within 4 DAYS of filing this form.

Note that by filling and submitting this form, you agree to the set out terms and conditions of our service provision.
Thank you.
Did you read the disclaimer & introductory note? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy