Sagar

Healing Support

Pre-Session Form

Before You Begin

This form helps me understand your situation better before we talk. There is no right or wrong answer here.

I am not here to judge you in any way.
Everything you share is private and confidential.
You can write as little or as much as you feel comfortable.

Basic Details

Full Name

Phone / WhatsApp Number

Email Address

Age (Optional)

Preferred Contact

Safety & Clarity

Are you currently taking treatment from a doctor, therapist, or psychiatrist?

Yes

If yes, are you coming here to replace that treatment?

Yes

Important Note

This session is meant only as support, not as a replacement for professional medical treatment.

What made you reach out for help at this time?

How You Feel Right Now

Right now, how heavy does this problem feel? 5/10

Very Light (0) Very Heavy (10)

Which sentence feels closest to how you feel right now?

Mostly calm, just thinking a lot

Emotionally tired or heavy

Anxious or restless

Confused or stuck

Numb or disconnected

How This Shows Up

When you think about this issue, what comes first?

Images or scenes in the mind

Thoughts or inner talking

Body feelings (tightness, heaviness, pain)

Not sure

Where do you feel this most in your body (if at all)?

Is this concern mostly about:

Something from the past

Something happening now

Something I'm worried about in the future

A mix of these

Impact on Daily Life

How much does this affect your daily life?

A little

Moderately

A lot

Does it affect any of these? (Select all that apply)

Sleep

Work / Studies

Relationships

Focus / Energy

Mood

None of these

Have you felt something similar before in your life?

Yes

Not sure

Support & Readiness

What usually helps you even a little when things feel difficult?

What would make this session helpful for you?

Are you open to gentle exercises during the session (like awareness or imagination), not just talking?

Thank you for sharing

You are not weak for needing support. You are not broken.

This form helps me prepare better for you.

We will go at your pace, with respect and care.

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Please fill in all required fields to continue.

Sagar