Manav Mind Wellness: Appointment form
Fill the details in the form below.
Full Name
*
Age
*
Gender
*
Male
Female
Other
E-mail Address
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Place
*
Preferred Language
*
Hindi
English
Both (Hindi, English)
Terms & Conditions:- You are interested to take Counseling/Therapy sessions with Manav Mind Wellness where sessions will be taken by Psychologist Tanu Manav. The above mentioned details of the client/ patient will be used for session and record purposes only. The duration of each session will be from 30 min. to 45 min. The Fee has to be paid before each session in order to book your appointment. The below-mentioned fee is non-refundable once the appointment is booked for a particular day and time respectively but the session can be rescheduled with the prior information by the Client/ Patient or by the Psychologist.
*
I Agree
If you are a student: Upload the Image of updated Student ID
Browse Files
Cancel
of
Choose your Package:
*
Per online session: INR 799 (For students: INR 699)
5 online sessions: INR 3600 (For students: INR 3300)
Payment details :
*
1) Bank- Syndicate Bank, Account Holder Name- Tanu Manav, Account no- 91682010018539, IFSC- CNRB0019168
2) Bank- Canara Bank, Account Holder Name- Pawan Kumar, Account no- 6060101004764, IFSC- CNRB0006060
Please Upload Payment Proof (Screenshot)
*
Browse Files
Cancel
of
Appointment
*
Thank you for choosing us
For any assistance, Kindly Email us at : manavmindwellness@gmail.com or Dm us on our Instagram Handle : @manavmindwellness.
Book Appointment
Should be Empty: