Book a Therapy Session Now Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *WhatsApp No. *Age *What is your Gender Identity?Cis ManCis WomanTrans manTrans WomanIntersexNon BinaryOtherPronounSexual Orientation *GayLesbianBisexualHeterosexual/StraightPansexualAsexualOtherOccupation *Prefered mode of SessionVirtual/Online SessionPhysical Session (TIERs Office, Lekki Phase 1, Lagos Nigeria)In the Last 3 months, have you had or currently experiencing any significant life change/stressor? *FrequentlySometimesRarelyNeverLoss of interest in pleasurable activities *FrequentlySometimesRarelyNeverConsistently depressed or down nearly everyday *FrequentlySometimesRarelyNeverThink that you would be better off dead or wish you were dead *FrequentlySometimesRarelyNeverEngage in any recreational drug use (such as alcohol, cigarrete, stimulants, cannabis, tramadol, codeine, cocaine, tobacco etc.) *FrequentlySometimesRarelyNeverActual or threaten death, sexual violence or serious injury in the past *FrequentlySometimesRarelyNeverIntense need to do away with your gender features and the desire to have the features of the other gender *FrequentlySometimesRarelyNeverFeel unworthy of love, respect and incompetent about who you are and what you can do *FrequentlySometimesRarelyNeverExtreme mood swings/flunctuation *FrequentlySometimesRarelyNeverExtreme Anxiety *FrequentlySometimesRarelyNeverPhobia *FrequentlySometimesRarelyNeverSleep Disturbance *FrequentlySometimesRarelyNeverPanic Attack *FrequentlySometimesRarelyNever cocaine, of (e.g, Hallucination *FrequentlySometimesRarelyNeverRepetitive thoughts (e.g, Obsession) *FrequentlySometimesRarelyNeverTell youe therapist why you are booking for session (Please fell free to express how you feel) *Submit
