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Age*
less than 18 years
18 - 35 years
more than 35 years
Preferred Language*
English
Hindi
Other
Preferred Mode of Counseling*
Voice
Video
Any
Preferred days for counseling*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any day
Preferred time*
Morning
Afternoon
Evening
Night
Any time
Counseling for*
Home Quarantine
Anxiety
Stress
Depression
Relationship
Health Management
Other
Have you attended any session with any psychologist or psychiatrist prior to this?*
Yes
No
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