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Counseling (Pre-Assessment form)

Hey there,

Thank you for being part of Project Green Circle (PGC). If you’ve reached this form, it means you’re already one step closer to prioritizing your mental and emotional wellbeing for yourself or for someone you care about .

This is a pre-assessment and registration form for counseling. Filling this form will help us understand you better and ensure that you receive the right kind of support, from the right professional, at the right time.

This form will help :

-Identify the best counselor for you from our team of 20+ counselors

-Understand whether counseling is the best option for your concern or if another service (such as psychiatric support, medical referral, or crisis intervention)

- The information you provide will be shared only with your assigned counselor and the Project Green Circle management team, strictly for coordination purposes and will be kept highly confidential.

Once you fill out this form, our team will contact you to guide you through the next steps of the counseling process.

Client full name

Counseling (Pre-Assessment form)

Client full name

Form filled by (If you re filling form for others)

Phone Number

Email

Gender

Age

Address (City/Country )

Counselor preference

Preferred language for counseling

Counseling preference date

Counseling preference time (Nepal Time/NPT)