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Assessment
Assessment
Pre-Counselling Assessment Form
Please fill out this Self Evaluation/Assessment form, to help me get to know you before your session, as this will help me proceed, while respecting your privacy.
How did you hear about Ernest Toho?
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Select a Session Type
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60 Minutes Virtual Counselling
90 Minutes Virtual Counselling
90 Minutes In-Person Counselling
120 Minutes Virtual Counselling
120 Minutes In-Person Counselling
Please select the counselling session type you paid for. Thank you.
What is your relationship status?
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Single (Never Married)
Single (Divorced)
Single (Widowed)
In Relationship (Unmarried)
In Situationship (Unmarried)
In Relationship (With Married Man)
In Relationship (With Married Woman)
It's Complicated
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Which issues best describes what you're currently facing?
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Struggles with finding a partner
Struggling with loneliness
Can't get out of a relationship
I can't keep a relationship
I need to get married asap
Low Self Esteem/Insecurities
Struggling with Drug Addiction
Struggling with Alcohol Addiction
Struggling with Rejection
Struggling with Depression
Struggling with Sex Addiction
Am addicted to Sex Toys
Sex performance related challenges
Dealing with sexual abuse
I have a bad character, I need help
I think am cursed/bewitched
I think I need deliverance
Other
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Your Name
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