Therapy history taking form
Hello,

Thank you for reaching out.

Plz fill your contact information correctly so that we can reach out to you easily.

This is a history taking form. Everything you fill here will be kept confidential. Filling this form helps us to know you better, but does not guarantee a slot as that would depend on availability and goodness of fit.


Charges per individual session 

With Sadaf: 

Living in India- Rs.2500

Living abroad: 60$

Studying abroad: 40$

With Aryan: 

Living in India- Rs.2000

Living abroad: 50$

Studying abroad: 35$

Rest of the therapists:

Living in India- Rs.1500

Living abroad: 40$

Studying abroad: 30$


Charges per couples session 

With Sadaf: 

Living in India- Rs.3000

Living abroad: 75$

Studying abroad: 55$

With Aryan: 

Living in India- Rs.2300

Living abroad: 65$

Studying abroad: 45$

Rest of the therapists:

Living in India- Rs.1800

Living abroad: 50$

Studying abroad: 40$


Each session is for about 45 mins to 50 mins. Cancellation charges are 100% if notified within 24 hours of the session, 50% notified between 48% - 24% hours of the session. Notified before atleast 3 days no cancellation charges. Plz note that we follow a fixed slot system hence no booking/no show will be assumed canceled as the slot has been reserved for you.


Email *
Name *
Email *
Age *
Phone number *
What app number (if it is same as calling number, plz put "same as above" *
Gender *
Pronoun *
Sexual orientation *
Caste *
Any disability  *
Briefly describe the issue/concern you need help with: *
Briefly describe what you would consider your strengths and unique traits: *
Briefly describe previous therapy/treatment experiences and learning, if any (also include past/current medication): *
Reference  *
As per your understanding, how often would you need sessions? *
How soon do you need to start therapy? *
About us: https://guftagutherapy.in/our-team please visit this link and let us know if you have any questions about us/any particular therapist/approaches we use or any other questions about the therapy process. *
First choice of therapist *
Second choice of therapist (Waitlist open) *
Preferred mode of therapy (plz select the slots in the next feild accordingly) *
Please pick a slot (Name: Day: Time: Frequency: Start date) Kindly read carefully. *
Fees I will pay (per session) *
I have filled this form to the best of my knowledge and I understand this doesn't guarantee a slot but starts a conversation about the possibility of it. I have read the payment and booking details made here and understood them/have asked clarifications wherever needed. You agree to cancellation policy. *
Required
A copy of your responses will be emailed to .
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