Client Intake Form

Share a little about yourself so we can prepare for a meaningful first session together.

Confidential
Secure
HIPAA-Mindful
What to Expect
This form takes about 5-7 minutes to complete

Personal Details

Basic contact information so I can reach you

Your Concerns

What's bringing you to therapy at this time

Scheduling

Preferred days and times for weekly sessions

Setup Note for Ayesha

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Booking & Cancellation Policy

All sessions operate on a strict 24-hour cancellation and advance-payment policy. Slots are confirmed only after fee clearance via the UPI link or QR provided at booking. Cancellations made less than 24 hours before the session are non-refundable.

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