Intake form

Name *

Email address *

What is your age group?

What is your occupation?

Which areas of mental health are you interested in?

Please select at least one option.

Personal growth

Stress management

Communication skills

Emotional well-being

Work-life balance

How did you hear about us?

What specific challenges are you currently facing?

How often do you seek support for mental health?

Are you currently receiving any mental health support?

What methods of support are you most interested in?

Please select at least one option.

Workshops

One-on-one sessions

Online resources

Group therapy

Webinars

Additional questions or comments

Mindvolta OAU