Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Desired Counseling Location

Select all that apply. (Hybrid option is available)

In-person: Geneva Webster Counseling Center

In-person: Zurich Counseling Center

Remote/Teletherapy

I don't know.

Reason for seeking counseling: *

You may select as many as you like.

Life adjustments

Social issues

Loneliness

Homesickness

Relationships

Exams

Work stress

Procrastination

Sleep problems

Low mood

Grief and bereavement

Identity issues

Other

I prefer not to say