Online Consultation

Full Name

Age

Gender
MaleFemale

City & Country

Email Address

Phone / WhatsApp Number

Preferred Method of Contact
PhoneWhatsAppEmail

Preferred Language
UrduEnglishOther

Reason for Consultation (short summary)

Have you previously received consultation or therapy for the same problem?
YesNo

If yes, please specify (duration, method, diagnosis if any)

Preferred Days/Time for Consultation

Consultation Charges: Rs. 700 per session

Payment Method
Easypaisa - 03212353595JazzCash - 03212353595Raast Id - 03212353595

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