Registration Form / 登记表格 - MY Psychology Centre / MY心理学心理咨商中心
你好,我们MY心理学的临床心理治疗师有提供面谈心理治疗
要了解更多关于面谈心理治疗的资讯,可以点击这里:
https://www.mypsychology.my/faq-face-to-face-psychotherapy/
如果你是在其他州的朋友,或者是你想要预约线上心理治疗可以点击这里:
http://bit.ly/registermypsychologyonline
第一次的心理咨询 (90分钟): RM250 (开张优惠)
联络号码:+6011-33445270 [WhatsApp]
Greeting! Our clinical psychologists at MY Psychology provide face-to-face psychotherapy services. To understand more about face-to-face psychotherapy, click the link here:
https://www.mypsychology.my/common-faq-en/
If you are from other states or are interested in online psychotherapy, you can click here:
http://bit.ly/registermypsychologyonline
1st Session (90 minutes): RM250. (Opening Offer)
Contact Us: +6011-33445270 [WhatsApp]
Our Centre Address / 心理咨商中心地址:
Location: Jalan Kepong, Pusat Niaga, 7-1, Jalan Prima 9, Metro Prima, 52100 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur
* Required
Name / 名字
*
Your answer
Email Address / 电邮
*
Your answer
Phone Number / 联络号码
*
Your answer
Birth Date / 出生日期
*
MM
/
DD
/
YYYY
IC / 身份证号码
*
Your answer
Preferred Method of Contact / 联络方式
*
Whatsapp Text
Phone Call / 电话联系
Email / 电邮
Gender / 性别
*
Male / 男生
Female / 女生
Prefer not to say / 不方便透露
Occupation / 职业
*
Your answer
Preferred Language / 语言
*
English / 英语
Malay / 马来
Chinese / 华语
Other:
Main reason to see a therapist / 咨询治疗师的主要原因
*
Your answer
Have you experienced any psychotherapy previously? / 请问你之前有接受过过心理治疗吗?
*
Yes / 有
No / 没有
Required
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
Your answer
How did you hear about us? / 你是如何得知我们的?
*
Google
Facebook
Friends or Family / 朋友或家人介绍
Other:
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