JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Online Counseling for Mental Health issues associated with COVID-19 (Contact Information)
From CENTRE FOR PSYCHOLOGICAL ASSESSMENT AND COUNSELLING, DEPARTMENT OF PSYCHOLOGY, ADIKAVI NANNAYA UNIVERSITY, RAJAMAHENDRAVARAM, ANDHRA PRADESH
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Address
*
Your answer
Phone number
*
Your answer
Preferable Language
Telugu
English
Hindi
Clear selection
Counselling For
Yourself
Other:
Clear selection
Age
Your answer
Marital Status
Your answer
Living With
Your answer
Reason for Seeking Counselling
Your answer
Severity of your problem
Very Low
1
2
3
4
5
Extreme
Clear selection
Undertaking: I hereby declare that all the information given by me in this application is true and correct to the best of my knowledge. I am agree to seek counseling, I hereby oath to not cause any harm to myself or take any action that would be harmful to my health and well-being during the process of counseling
*
Agree
Disagree
Undertaking: I am aware the counseling process is online through verbal-audio medium. I hereby submit that I would not involve in any form of recording of the session or it’s sharing in any form. I will only keep my mic and audio output active during counseling, and turn off the video camera before I enter the online counseling session.
*
Agree
Disagree
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
