General Guidelines

Read the following guidelines before filling the assesment form.

  • Navodaya is a Day Service providing psychological treatments & specialized day services.
  • Since clinical assessment has to be done, only general bookings can be accommodated via online.
  • The service will not allow immediate bookings but with a 3 working day gap (Saturday & Sunday not included).
  • This is only for booking and for emergencies to come to NIMH or nearest hospital.
  • Followinf form has to be filled for all sessions even for repeat patients as mental states can change.
  • The Navodaya team will assess the form and contact the patient and confirm your booking.

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    Name in Full:

    Permanent Address:

    Temporary Address:

    Age:

    Home Phone Number:

    Mobile Phone Number:

    Education Level:

    Occupation:

    Gender

    Marital Status:

    My general physical health is:

    Are you currently on any medication:

    If ‘Yes’ Please write your medication:

    Are you currently experiencing any chronic pain:

    I’m currently having the following issues (check all that apply)*
    Other:
    Have you ever received psychotherapy or psychiatry treatment:

    Do you have a family history of mental illness:

    If ‘Yes’ Please give details:

    Are you currently under treatment for psychiatric illness:

    If ‘Yes’ Please give details: