Help us match you to the right therapist

Filling out this questionnaire will offer Saarathi, the necessary information about your background as well as the issues you are facing which will then help us match the right helping professional for you. Further your answers will also enable the helping professional to understand you better and prepare for interacting with you.

Gender

Male
Female
Other

How old are you?


What is your relationship status?

Single
In a relationship
Married
Separated
Divorced

Are you currently employed?

No
Yes

What type of service are you looking for?

Personal Counseling (for yourself)
Couple Counseling (for yourself and your partner)
Family Counseling (family including children)
Coaching (Life, Career)

Have you taken any counseling, therapy or coaching services before?

No
Yes

Please rate the following on a scale of 1 to 10

How would you rate your physical health?

How would you rate your sleep?

How would you rate your appetite?

How would you rate your work situation?

How would you rate your financial situation?

Are you currently experiencing any of the following?

Anxiety, panic attacks?
Any kind of phobias?
Any chronic pain?
Trouble Falling Asleep?
Sleeping too much or sleeping too little?
Feeling tired or having little energy?
Poor appetite or over eating?
Trouble concentrating?
Loss of interest or happiness in doing things?
Feeling that you are a failure?
Feeling that you have let yourself or others down?
Are you currently experiencing thoughts of hurting yourself?

Because of any of the problems you’re experiencing, how difficult has it become for you to attend to work, home or to get along with people?

No Difficulty
Somewhat Difficult
Quiet Difficult
Extremely Difficult

How likely is it that others around you have observed some changes in your behavior?

Unlikely
Quite Likely
Very Likely
Yes, they have

Are you currently taking any medication?

No
Yes

What's your Orientation?

Straight
Lesbian
Gay
Bisexual
Unsure

How did you happen to know about Saarathi?

Through a friend
Through a family member
My doctor recommended me
My therapist recommended me
Through an online search
Through social media
I read about Saarathi
Through TV/Radio
Other

Which is country of origin?


Which country of residence?


Which state are you from?


Language Preference: I can speak and converse in the following languages:


Note: Saarathi will make best efforts to take your preferences into consideration before matching the right professional for you. However please note this cannot be guaranteed.


Please share what you hope to achieve by taking the therapeutic counseling or coaching services and which issues you would like to address. This will help you develop clarity while at the same time helping help Saarathi match you with the right helping professional.


Thank you! You have completed the questionnaire.

Thank you for responding to the questions. We have captured the information you have provided for passing on to your therapist.

Next step you will be guided through the registration process.