Primary concern *
Select option
Stress or anxiety
Low mood or depression
Family or relationship concerns
Grief or loss
Work or study stress
Trauma or crisis impact
General wellbeing support
Prefer to discuss privately
Other
How long have you been experiencing this? *
Select option
Less than 1 month
1-3 months
3-6 months
6-12 months
More than 1 year
Prefer not to say
Have you received counseling or psychological support before?
Select option
Yes
No
Prefer not to say
Type of session preferred *
Select option
Initial consultation
Individual counseling
Psychosocial support
To be discussed
Preferred session mode *
Select option
Video call
Audio call only
Text / chat
Physical / face-to-face session
No preference
Preferred session language *
Select option
Dari
Pashto
English
Urdu
Arabic
No preference
Other
Preferred Date
Preferred time slot
Select option
Early morning
Morning
Midday
Afternoon
Evening
To be discussed
Counselor gender preference
Select option
Female
Male
No preference
