Counselling Booking Form - DFS Consulting
Psychological Counseling, Psychotherapy, Hypnotherapy, Life Coaching, Personal Development. Private Individual & Corporate Training, Seminars, Workshops & Employee Assistance Program (EAP)
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Counselling Booking Form

INDIVIDUAL COUNSELLING, COUPLES THERAPY, PSYCHOTHERAPY, LIFE COACHING, MENTAL HEALTH CLEARANCE, PSYCHOLOGICAL REPORTS, MEDICINE PRESCRIPTION

CONSULTATION HOURS

*Strictly By Appointment Only. No Walk-Ins.

 

ONLINE CONSULTATION (Chat/Voice/Video)

All Professionals (Psychologist, Psychiatrists, Doctors, Counselors & Coaches)

Mondays-Sundays: 24/7 (including weekends, after office hours & holidays)

 

FACE TO FACE CONSULTATION

Psychologist-Life Coach-Hypnotherapist

Saturdays, Sundays & Holidays: 12pm-9pm

*Wearing of face mask still required.

*Professional rates for online & F2F consults will differ.

    This booking is for SelfOthers

    Full Name
    Age
    Phone
    Email (please check email or Viber for confirmation)

    EMERGENCY CONTACT:
    Contact Person & Relationship
    EMERGENCY CONTACT:
    Contact Number

    Preferred Day and Time for Appointment (give options)
    How do you want to avail of the Service? ChatVoiceVideo with voiceFace to Face/Clinic

    Language Spoken TagalogEnglishBisayaCebuanoIlonggoChavacano

    What service do you wish to avail now?
    INDIVIDUAL: Assessment/Counselling/Therapy-PsychologistCOUPLES: LGBTQ+-PsychologistCOUPLES: Non-marital Counselling-PsychologistCOUPLES: Marital Counselling-PsychologistGROUP: Family Therapy-PsychologistGROUP: Coaching or Debriefing-PsychologistSCHOOL / COURT REPORTS: PsychologistMental Health CERTIFICATE (fit to work/ leave / resignation)-PsychologistMental Health CERTIFICATE-PWD ApplicationMEDICINE ePrescription-PsychiatristDOCTOR: Orthopedic (musculoskeletal)DOCTOR: ENT (ears nose throat)Financial/Wealth CoachWell-Being Coach (Nutrition, Sleep, Exercise)

    Where did you find us? If referred, please state name

    GC No. (skip this field if none)

    Primary Concerns/ Message / Notes (You can share what you're feeling, symptoms etc.)

    You have read, understood and agreed with the Confidentiality and Privacy AgreementYes

    NOTE: Please check your email for appointment confirmation or payment details.