IoBM Wellness Center

  • IoBM Wellness Center

    Any information provided here is secure and is not accessible by any unauthorized personnel. The only people other than you who can access this information is IoBM’s Mental Health Counsellor. Therefore, be confident that your privacy is ensured.
  • Format: (0000) 000-0000.
  • Gender*
  • Marital Status*
  • Employed*
  • Have you attended any session earlier?*
  • Which of the following modes of therapy are you comfortable with?*

  • Nature of Your Current Issue

    Please complete the test (questionnaire) with your true feelings and mental state. It will help us to devise a meaningful treatment /support plan for you. After completing the test you will be guided through email about your next course of action that leads to your appointment with a therapist
  • Please select one*

  • Questionnaire

  • Numbness or tingling*
  • Feeling hot*
  • Wobbliness in legs*
  • Unable to relax*
  • Fear of worst happening*
  • Dizzy or lightheaded*
  • Heart pounding/racing*
  • Unsteady*
  • Terrified or afraid*
  • Nervous*
  • Feeling of chocking*
  • Hands trembling*
  • Shaky/unsteady*
  • Fear of losing control*
  • Difficulty in breathing*
  • Fear of dying*
  • Scared*
  • Indigestion*
  • Faint/Lightheaded*
  • Face flushed*
  • Hot/Cold Sweats*
  • Little interest or pleasure in doing things*
  • Feeling down, depressed or hopeless*
  • Trouble falling or staying asleep, or sleeping too much*
  • Feeling tired or having little energy*
  • Poor appetite or overeating*
  • feeling bad about yourself - or that you are a failure or have let yourself or your family down*
  • Trouble concentrating on things, such as reading the newspaper or watching television*
  • Moving or speaking so slowly that other people could have notice, or the opposite - being so fidgety or restless that you have been moving around a lot more than usual*
  • Thoughts that you would be better off dead, or of hurting yourself*

  • Degree Related Concern

  • Appointment

  • What is your preferred medium of counseling?
  • Appointment
  • Should be Empty: