Partners – Alharub Medical

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Way 2830, House 2264, Sarooj – Shatti Al-Qurum, PO Box 113, PC 118, Oman Way No.1958, Building No.4492, Al Mawaleh, Muscat, Oman
Al Qurum: +968 2460 0750 | +968 9170 5886
Al Mawaleh: +968 2427 1789 | +968 7150 0095
info@alharubmedical.com

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Appointment Form

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Tell Us About You
Your Preferences
Your Current Situation

What brings you here today?

Anxiety or panic

Depression or low mood

Trauma or PTSD

Relationship or marital issues *

Parenting or family stress

Work or burnout-related stress

Body image or eating concerns

Grief or loss

I’m not sure I just need support

Other

If Other, please specify

Have you been in therapy before?

Yes

No

What is your age group?

Under 18

18–25

26–40

41–60

60+

What type of therapy are you looking for?

Individual therapy

Couples or marriage counseling

Family therapy

Child or adolescent therapy

Do you have a preference for your therapist’s gender?

No preference

Male

Female

What session format do you prefer?

In-person

Online

No preference

If you selected In-person: Which location works best for you?

Shatti Al Qurum

Al Mawaleh

Other:

If Other, please specify

What language do you prefer for your sessions?

English

Arabic

Both English and Arabic

Other:

How would you describe your current level of distress?

Mild – I need guidance to stay well

Moderate – It’s affecting my daily life

Severe – I’m struggling to cope

Are you currently taking psychiatric medication or receiving psychiatric care?

Yes

No

Prefer not to say

Are there specific qualities or considerations for your therapist that matter to you?

Faith-sensitive or Islamic perspective

Trauma-informed

Neurodiversity-aware

Female empowerment focus

None of the above / Not sure

Do you have a specific therapeutic approach in mind? (Optional – skip if unsure)

Cognitive Behavioral Therapy (CBT)

Acceptance & Commitment Therapy (ACT)

Trauma-focused therapy

Psychodynamic/insight-oriented

Not sure – I’d like guidance

Name *

Phone *

Email Address

Service *

Date *

Time *

Hours

Minutes