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Basic Information

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Full Name *

Email Address *

Phone Number *

Gender *

Date of Birth *

Country *

State *

City *

Therapy Preferences

Preferred Contact *

Looking For

Session Mode

Therapist Gender

Budget (INR)

Preferred Time Slot

Concerns (Select all that apply)

Depression

Anxiety

Stress

Relationship issues

Sleep problems

Self-esteem

Preferred Days

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Therapist Languages

English

Hindi

Regional

Current Medications (if any)

Previous Therapy Experience

Previous Therapy Details

Emergency Contact & Security

Emergency Contact Name

Emergency Phone

Relation

Notification Preferences

Email

SMS

App Notification

Password *

Confirm Password *

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Please review all your information before submitting. Once submitted, you'll be able to start your therapy journey with us.

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