PICS Nepal – Counseling Enquiry Form Feeling low, sad or just need a talk-We’re here for you. Fill this form, we’ll get back to you. Full Name Age How do you identify Yourself: Male Female Other What’s your relationship status? Single Married Divorced Widowed Other Contact Email Occupation Your Preferred Language for Counseling: Nepali English Other Have you ever taken Counseling Session or Is this your First Time? Yes No Are you aware of the reason you are seeking counseling services? Yes No Preferred Session Type: In-Person Online(Zoom/Meet) Preferred Time for Sessions: Morning Afternoon Evening Specific days or Time Where did you hear about PICS Nepal? Facebook Google Search Friend/colleague Instagram Were you referred by someone? Yes No Select the Counselor Binod Paudel Anjan Kumar Dhakal Padam Raj Joshi Nabin Prasad Joshi Yubaraj Karki Anju Shah Manisha Koirala Preeti Adhikari Santosh Acharya Salomi Baniya Chhetri Rashmee Bharati Genelia Shrestha Riyani Sharma Choose Counseling Package Select Package General Counseling Service package Student Package with ID Card Online Package for nepali living abroad Price Select Session Payment Method QR Bank Transfer Bank Details Account Number:0970991179100016 Bank Name:Machhapuchre Bank Account Name:Psychotherapy and Integrated Counseling Services Nepal Reciept Register for Counselling WoM - Academy ©2025 All Rights Reserved. Facebook Instagram Youtube Tiktok Linkedin
