Let’s Start Therapy

Choosing a therapist is a deeply personal decision. It’s about finding a space where you feel seen and safe. This page is a simple, gentle way to enquire about starting therapy, whether for yourself or for your relationship.

Form for Individual Therapy

Choosing a therapist is a deeply personal decision. This enquiry is a simple, no-obligation way to share a bit about what you’re looking for and start the conversation about beginning therapy together.

First Name*

Last Name*

Email Address*

Phone Number*

Birthday*

Day

Month

Year

Briefly what do you need support with?

Preferred Days/Times

Emergency Contact (Name and Phone number)

What are the top 2–3 concerns you would like support with?

Anxiety/Stress

Low Mood/Depression

Relationship Difficulties

Family Concerns

Work/Academic Stress

Self-Esteem

Grief/Loss

Trauma/Past Experiences

Life Transitions

Other

Have you attended therapy before?

Yes

Is there anything important you would like me to know before our first session?

Submitting this form does not confirm an appointment. We will get back to you regarding therapist availability and the next steps for beginning your care.

Form for Couples Therapy

Sharing these details helps us understand the dynamics and specific needs of your relationship before we begin.

Partner 1

Partner 1 name*

Partner 1 age*

Partner 2

Partner 2 name*

Partner 2 age*

Contact Us

Have questions before you start? Reach out anytime.

Name*

Email*

Message*

Vaishali Nagar, Jaipur Raj. 302021

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reachout@ataraxia.co.in

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