Registration Form / 登记表格 - MY Psychology Centre / MY心理学心理咨商中心
Duration/时长:
1st Session / 第一次的心理咨询 - 90 minutes
Price/价钱: RM 200

Location/地点: Jalan Kepong, Pusat Niaga, 7-1, Jalan Prima 9, Metro Prima, 52100 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur

Contact Us/联络号码: +6011-33445270 [WhatsApp]
Name / 名字 *
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Email Address / 电邮 *
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Phone Number / 联络号码 *
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Birth Date / 出生日期 *
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IC / 身份证号码 *
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Preferred Method of Contact / 联络方式 *
Gender / 性别 *
Occupation / 职业 *
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Preferred Language / 语言 *
Main reason to see a therapist / 咨询治疗师的主要原因 *
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Have you experienced any psychotherapy previously? / 请问你之前有接受过过心理治疗吗? *
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Preferred Times for Appointment (e.g. Mon, 10am - 3pm), Tue (3pm to 6pm) / 适合的诊疗时间(例如:星期一,10am to 3pm / 星期二, 3pm to 6pm)*Please suggest more than one time slot. 请填写超过一个适和的诊疗时间 *
Please suggest more than one time slot. 请填写超过一个适和的诊疗时间
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How did you hear about us? / 你是如何得知我们的? *
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