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History of Previous Treatment Related to StutteringSelectYesNo

If Yes, then specify the type of treatment SelectMedication (Allopathic)HomeopathicHerbalSpeech TherapyAny OtherNo Treatment

From where you get information about SAY Global-Pakistan Stammering Foundation ? SelectFacebookInstagramTwitterWhatsappLinkedinEmailYoutubeSnapchatFriendWebsitePrinted MediaAwareness Tele MarketingOther

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Mode of Taking Sessions From SAY Global – PBM
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From where you get information about SAY Global-PBM SelectBy Social MediaFacebookInstagramThrough a FriendTwitterLinkedinWebsitePrinted MediaSnapChatYoutubeWhatsAppOther

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Choose from these Clinical Psychologist SelectMs. Hina Rana (3000)Ms. Isra (2000)Ms. Iqra (2000)Mr. Zain (2000)Ms. Alena (2000)Ms. Farwa (2000)Ms. Sumaira (2000)Ms. Fizzah (2000)

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Your name

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PTCL Number / Cell Number

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Email ID

Emergency Contact Person Name

Relation with Emergency Contact Person

Emergency Contact Number

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Languages you Speak

History of Previous Treatment Related to StutteringSelectYesNo

If Yes, then specify the type of treatment SelectMedication (Allopathic)HomeopathicHerbalSpeech TherapyAny OtherNo Treatment

From where you get information about SAY Global-Pakistan Stammering Foundation ? SelectFacebookInstagramTwitterWhatsappLinkedinEmailYoutubeSnapchatFriendWebsitePrinted MediaAwareness Tele MarketingOther

This form was filled by SelectSelfMotherFatherOther

Select Payment Mode
SelectJazz Cash (0321 47 11 407)Telenor EasyPaisa (0345 42 42 506)Meezan Bank Account (0231 – 0101717462)IBAN ACCOUNT NO: PK86MEZN0002310101717462

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Your name

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SelectMaleFemaleOther

PTCL Number / Cell Number

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Email ID

Emergency Contact Person Name

Relation with Emergency Contact Person

Emergency Contact Person Number

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History of Previous Treatment Related to StutteringSelectYesNo

If Yes, then specify the type of treatment SelectMedication (Allopathic)HomeopathicHerbalSpeech TherapyAny OtherNo Treatment

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Choose from these Speech therapist SelectMs. Hina (3000)Ms. Munaza (2000)Ms. Amber (2000)

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SelectJazz Cash (0321 47 11 407)Telenor EasyPaisa (0345 42 42 506)Meezan Bank Account (0231 – 0101717462)IBAN ACCOUNT NO: PK86MEZN0002310101717462

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Your name

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PTCL Number / Cell Number

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History of Previous Treatment Related to ArticulationSelectYesNo

If Yes, then specify the type of treatment SelectMedication (Allopathic)HomeopathicHerbalSpeech TherapyAny Other

Mode of Taking Sessions From SAY Global – ITS(AM)
SelectFace-Face (In-person) Session at ClinicOnline Session

From where you get information about SAY Global – ITS(AM) SelectFacebookInstagramThrough a FriendSnapchatYoutubeLinkedInWhatsAppEmailWebsitePrinted MediaAwareness Tele CallOther

This form was filled by SelectSelfMotherFatherOther

Choose from these Speech therapist SelectMs. Hina (3000)Ms. Munaza (2000)Ms. Amber (2000)

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SelectJazz Cash (0321 47 11 407)Telenor EasyPaisa (0345 42 42 506)Meezan Bank Account (0231 – 0101717462)IBAN ACCOUNT NO: PK86MEZN0002310101717462

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Your name

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Psychological problems you are facing

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SelectSupport Group for Depressive ProblemsSupport Group for Panic Attacks ProblemSupport Group for Stress Problems

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I would like to join
SelectOn Venue (face to face) physical meetupOnline through zoom

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