Midnight Listeners

Book Midnight Listeners Session

    Please complete the forms below to book your Midnight Listeners session

    All fields marked * are compulsory

    Name: *

    Email: *

    Phone No.: *

    Marital Status: *

    Gender: *

    Age: *


    Statement of Intent and Confidentiality

    Current Situation: *

    Counselling Preferences:

    Individual Counselling: *

    Group Counselling (OPTIONAL):

    Preferred Marital Status of Your Requested Coach: *

    Preferred Gender of Your Requested Coach: *

    Preferred Religion of Your Requested Coach: *

    Preferred Day of the week: *

    Preferred Call time at night: *

    I have decided to work with the Midnight Listeners because of: *

    These are my expectations from the sessions: *

    I AGREE THAT EVERYTHING WE DISCUSS WILL BE CONFIDENTIAL, EXCEPT IF IT WOULD HARM ME OR SOMEONE ELSE AND I AM RESPONSIBLE FOR MY COMMITMENT TO ACHIEVING MY OUTCOMES.

    I CERTIFY THAT I AM EMOTIONALLY PREPARED, PHYSICALLY SOUND AND FINANCIALLY READY TO UNDERGO MY SESSIONS

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