Welcome to your therapy journey.

Hello, I’m Mahika Bakshi.At Mosaic Minds, we believe everyone deserves to feel happy, healthy, and whole.This is a safe and supportive space to explore your thoughts, feelings, and challenges.

Confidentiality

All information you share is treated as strictly confidential.

Compassionate care

A safe, supportive space to be heard without judgment and work towards your goals.

Empowerment

Tools and resources to help you navigate life’s challenges with greater confidence.

Before you begin

Please read and complete all details carefully.
After submission, Mahika will review your information and contact you within two business days to discuss your needs, if required, and schedule the initial appointment.
Once you are onboarded, you will receive a formal payment email. After payment is completed, your therapist will share your session link.

Ready to begin your journey? Let’s get started.

Mosaic Minds Therapy Intake Form

Please read each question carefully and complete all required fields. Share only what you feel comfortable sharing at this stage.

First nameLast nameAgeGenderPhone numberPlease provide a number that is also available on WhatsApp.Email IDOccupationCurrent country of residence

Type of therapy

Individual therapyCouple therapy

Reason for seeking therapySession day preferenceSession time preferenceHow did you hear about Mosaic Minds?I consent to Mosaic Minds securely storing the information in this form so Mahika can review my request, contact me, and arrange therapy services. I understand that this form does not constitute therapy.

Your information is stored in a restricted Firestore collection and is visible only to authorised Mosaic Minds owner accounts. This form is not suitable for emergency or crisis support.