ParampriyoCHILD DEVELOPMENT & COUNSELLINGBack to website
BEFORE YOUR FIRST SESSION

Help us understand
what brings you here.

New Client Intake & Assessment Form

Share only what you feel comfortable sharing. History questions are optional, and you can discuss them in person instead. This form helps start a conversation; it does not provide a diagnosis or confirm an appointment.

Your answers stay on this page until you choose to share them.

We don’t save this form on the website. “Review & email” opens your email app with your answers addressed to param.priyo.007@gmail.com. You must press Send there. Email isn’t a confidential clinical portal; you may prefer to bring a downloaded copy to your session.

Fields marked * are required. Please use this form for yourself or a child in your care.

Who is the support for?

For a baby, you can enter 0 and add their age in months later.

Please don’t include Aadhaar numbers, identity documents or a full home address.

Step 1 of 4

Questions about the form? Call +91 98303 76819. Closing or refreshing this page clears your answers.