Welcome to Nsansa Wellness Centre! We're here to help you find the right therapist for your needs. Please take a few minutes to provide us with some information to create your comprehensive client profile. Your responses will be kept confidential and will be used solely for the purpose of matching you with a suitable therapist. Let's get started

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Full Name

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Date of Birth

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Gender

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Marital Status

Single Married Divorced Widowed

Contact Email (Required)

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Phone Number (Required)

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Please provide the full name and phone number of your emergency contact (Required)

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What are the main reasons you're seeking therapy?

Anxiety Depression Relationship Issues Trauma Grief and Loss Stress Management Self-Esteem and Confidence My mood is interfering with my job/school performance I struggle with building or maintaining relationships I can’t find purpose or meaning in my life I need to talk through a specific challenge Other

Have you ever done therapy before?

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Please provide your residential address (Required)

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Have you been diagnosed with any medical conditions? If yes, please provide details

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Have you been diagnosed with any mental health disorders? If yes, please provide details

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Preferred mode of communicating with your therapist?

Via audio only Via Video sessions Not sure yet (decide later)

Preferred gender of therapist

Man Woman Any

Is there any additional information you'd like to share that you believe would help us match you with the right therapist? (optional)

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Who would you prefer to see?

Peer Counselor (starting at K150) Psychologists (starting at K450)

Thank you for providing us with this important information. We're dedicated to connecting you with a therapist who can best support your needs. You're one step closer to a personalized therapy experience!

Thank you!