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Your Name
*
First
Last
Your Mobile Number
*
Your Email ID
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Your Taluk
*
Your District
*
Case 1 - Select the Issues which seem relatable to you
*
I am unable to sleep
I am not feeling hungry
I am very much malnourished
I have physical illness
I am suffering from psychological issue
I am unable to focus on my wellness
I want to know more about spiritual health
I am addicted to alcohol/tobacco/cell phone/internet
None of the above
Case 2 - Select the Issues which seem relatable to you
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I have problems with my parents
I have problems with my granddaughter/grandson/grandfather/grandmother
I have problems with my boyfriend/girlfriend/wife/husband/partner
I have fought with my friends
I have trouble with a friend whom I met online
I have problems in communicating with people
None of the above
Case 3 - Select the Issues which seem relatable to you
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I need to know more about myself
My self-esteem is low and I want to build it
I have too many emotional issues
I have a disturbed thinking pattern
I lack skills to handle negative emotions
None of the above
Case 4 - Select the Issues which seem relatable to you
*
I am injured and I want to know more about first aid
I need information on legal aspects
I need to have more information on cyber safety
I am undergoing gender based violence at workplace/college/home
I have suicidal ideations or I feel like committing suicide
None of the above
Case 5 - Select the Issues which seem relatable to you
*
I need to have a goal in my life. Currently I do not know what to do
I need to improve my concentration
I need to improve my memory
I have exam anxiety
I am stressed about my education and career ahead
I need to manage my time better
I am being ragged or bullied by my superiors/colleagues/friends
None of the above
Case 6 - Select the Issues which seem relatable to you
*
I need to know about gender roles
I am a victim of gender discrimination and I need help
I am going through gender based violence
I am undergoing gender based violence at workplace/college/home
Me/My child/my friend/my colleague is sexually abused
I have sexually transmitted disease
None of the above
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