LET'S KNOW BETTER PART-3

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(The data collected will be used only for counselling, therapy and research purpose without disclosing the identity of the client. Confidentiality of data is assured. Please answer all the questions. If you don't want to disclose any details please mention it.)

Name/Nick name (May not provide real name) *

1) A short description of your current problem *

2) How long you had been experiencing the current problem? *

3) On a scale of 1 to 10 how intense is your problem? *

4) On a scale of 1 to 10 how intense does it affect your daily activities and life. *

5) The reason for the current problem- as you perceive *

6) Did you come for counselling by the compulsion of others or on your own interest? *

7) You think one of your friend is experiencing a similar problem that you are experiencing now, can you give him any advice or suggestions? If yes what advice/suggestion would you give him? *

8) The most supportive person in your life is----- *

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