Application to Buddy System
We have a team of trained primary respondents who will listen to your difficulties and
provide you with support in a completely confidential and non judgement manner. It is a
free of cost service which you can use when you are upset and feel the need to be heard.
They are like your pre-therapist or your "buddy"; to provide you with emotional first aid. The information we collect is solely for documentation in order to provide the right buddy for you. This form and it’s information is also confidential.
Email *
Name *
Age *
Your Contact No. *
Email Address
Gender *
Have you ever sought professional help before? *
Do you have a support system? *
How would you like to meet your buddy? *
Emergency Contact *
Do you have a history of self harm? *
Are you currently dealing with suicidal ideation? *
Do you have a history of attempted suicide/suicidal ideation? *
Brief description of the issues you would discuss with your buddy. (Does not have to be detailed, will remain confidential and will strictly be used for assignment of the right buddy) *
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