Consultation Screening

Yes, currentlyYes, in the pastNo, this is my first time
YesNo
If yes, what medication are you currently on:
Are you looking for:*
Are you planning to use medical aid or pay privately?*
YesNo
If yes, please describe if you are currently receiving support
Note: If you are in crisis or need immediate support, please call 10111 (police) or 10177 (ambulance).

For suicide hotline support, please contact South African Depression and Anxiety Group (24 hour Toll Free Emergency Helpline) at:

0800 567 567 OR SMS 31393

Psychology TodayTherapy RouteSocial MediaGoogle SearchReferral from friend/familyOther
Anything else you would like me to know?
Should be Empty: