EMERGENCY CONTACTPlease provide reliable contact of someone who can be reached out in case of emergency.

Thank you for providing us with your details.I have read and discussed the above information and I agree to the terms and conditions. I understand the risks and benefits of counseling, the nature and limits of confidentiality and what is expected of me as a client of the Counseling Services.

If you have any questions or doubts please feel free to reach out to me via e-mail at Rooshi.hashmi@gmail.com Please fill and sign the form below, indicating your consent to be part of the therapy.