Introduction
Every individual has unique mental health needs, which is why personalized care is essential. The Performa Request Form at Ramya Clinic helps us gather the necessary information to understand your concerns before your consultation. This allows our clinical psychologist to prepare a personalized assessment and recommend the most appropriate counseling or therapy plan.
Whether you are seeking help for anxiety, depression, relationship issues, child behavioral concerns, or career guidance, completing the Performa Request Form is the first step toward receiving professional mental health support.
What Is a Performa Request Form?
A Performa Request Form is a preliminary information form that allows clients to share essential details about themselves, their concerns, and the type of psychological support they are seeking.
The information provided helps our team:
- Understand your mental health concerns
- Prepare for your consultation
- Recommend appropriate therapy services
- Reduce paperwork during your appointment
- Provide personalized care from the very first session
Why Complete the Performa Request Form?
Completing the form before your appointment offers several benefits:
- Faster appointment process
- Better understanding of your concerns
- Personalized therapy recommendations
- More effective first consultation
- Improved communication with your psychologist
- Efficient clinical documentation
Who Can Fill Out the Form?
The Performa Request Form is suitable for:
- Adults seeking counseling or therapy
- Children (completed by parents or guardians)
- Adolescents
- Couples
- Families
- Students
- Individuals seeking psychological assessments
- Clients requesting online consultations
Information You May Be Asked to Provide
To help us understand your needs, the form may include:
Personal Information
- Full Name
- Age
- Gender
- Contact Number
- Email Address
- City or Location
Consultation Details
- Preferred consultation mode (Online or In-Person)
- Preferred appointment date and time
- Reason for consultation
Mental Health Concerns
You may indicate concerns such as:
- Anxiety
- Depression
- Stress
- Relationship Issues
- Marriage Counseling
- Family Conflicts
- Child Behavioral Concerns
- Student Counseling
- Career Guidance
- Emotional Difficulties
- Panic Attacks
- OCD
- Sleep Problems
- Trauma
- Other psychological concerns
Our Commitment to Privacy
At Ramya Clinic, we understand the importance of confidentiality. All information submitted through the Performa Request Form is handled with the highest level of privacy and professionalism.
Your information is used solely for clinical assessment, appointment scheduling, and providing appropriate mental health services.
After You Submit the Form
Once your request is received:
- Our team reviews the information provided.
- We contact you to confirm your appointment.
- Your consultation is scheduled based on availability.
- During your first session, the psychologist discusses your concerns and recommends a personalized treatment plan.
Why Choose Ramya Clinic?
Ramya Clinic is committed to providing compassionate, ethical, and evidence-based mental healthcare.
We Offer
- Individual Counseling
- Couple Counseling
- Family Therapy
- Child & Adolescent Counseling
- Student Counseling
- Career Counseling
- Psychological Assessments
- Online Consultations
- In-Person Therapy
- Confidential Mental Health Support
Our goal is to create a safe and supportive environment where every client feels heard, respected, and empowered.
Start Your Mental Wellness Journey
Taking the first step toward better mental health begins with reaching out for support. Completing the Performa Request Form helps us understand your needs so we can provide personalized care from your very first consultation.
Whether you’re seeking guidance for yourself or a loved one, Ramya Clinic is here to support you with professional, compassionate, and confidential mental health services.
Complete your Performa Request Form today and take the first step toward emotional well-being.
Frequently Asked Questions (FAQs)
Is the Performa Request Form mandatory?
While it may not always be mandatory, completing the form helps us prepare for your consultation and provide more personalized care.
Is my information confidential?
Yes. All personal and medical information shared through the form is treated as confidential and handled according to professional ethical standards.
Can I request an online consultation?
Yes. You can indicate your preference for either an online or in-person consultation when completing the form.
Can parents complete the form for their child?
Yes. Parents or legal guardians can complete the form on behalf of children or adolescents seeking counseling or therapy.