Jivan Clinic

Book Your Appointment

Take the first step toward healing. Fill out the form below and we’ll get back to you within 24 hours to confirm your appointment.

Initial Mental Health Consultation Appointment Request

Please provide your basic personal details below.

First Name

Last Name

Phone Number

Country of Residence

City

Please provide details about your appointment request.

Preferred Therapist

Preferred Availability

Preferred Session Format

In-person

Online

Brief Reason for Contact

Your safety is our priority. Please answer the following questions honestly.

Are you currently experiencing thoughts of self-harm or suicide?

Yes

Are you currently safe?

Yes