XinYu Counseling Registered Form
Please fill out the following 10 simple questions to start the  Process. If you have any question, Please email XinYu at ( xinyu58.psy@gmail.com ) or phone:  0910-080-536. We will get back to you within 3 days.

XINYU COUNSELING CLNIC 
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1. Name  *
2.Contact Phone No. *
3.Email *
4.Gender  *
5.Date of Birth *
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6. Available time for the phone intake in the following week (e.g. Mon. 4-7 PM/Thu. anytime after 2 PM) ? *
7.  Available time for therapy (e.g. Mon. 4-7 PM/Thu. anytime after 2 PM) *
8.Prefer Counseling Settings *
9.How do you know about XinYu? *
10. Any question you would like us to know before the phone intake?
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