2 minutes
The Employee Counselling Form is available for all employees. If any employee is dealing with work-related concerns or problems they can fill out this form.
Employee Name
Phone Number
Email ID
Department
Supervisor's Name
Reasons for Counselling
Could you explain why you're seeking counselling in more detail?
Do you have any medical condition ?
Any history of mental illness in your family?
Are you referring someone else as a counsellor?
Are you comfortable discussing personal issues with your supervisor?
Please sign below to confirm that the information you have provided is correct to the best of your knowledge.