Registration Form / 登记表格 - MY Psychology Centre / MY心理学心理咨商中心


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:

If you are from other states or are interested in online psychotherapy, you can click here:

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
Name / 名字 *
Email Address / 电邮 *
Phone Number / 联络号码 *
Birth Date / 出生日期 *
IC / 身份证号码 *
Preferred Method of Contact / 联络方式 *
Gender / 性别 *
Occupation / 职业 *
Preferred Language / 语言 *
Main reason to see a therapist / 咨询治疗师的主要原因 *
Have you experienced any psychotherapy previously? / 请问你之前有接受过过心理治疗吗? *
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
How did you hear about us? / 你是如何得知我们的? *
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