Counselling Request Form
Our counselling service is a ministry and community service made possible by Full Gospel Assembly Kuala Lumpur. Our counsellors consist of professionally trained, licensed or pre-licensed counsellors. We offer face-to-face (only) counselling sessions by appointment.

Please fill out this form to request counselling support from us. We'll reach out to you via email ( or WhatsApp (011-5915 2069) to register and schedule your initial appointment. Due to limited counsellor availability, please anticipate a minimum wait of 14 days from the request date to your first appointment date.

Our centre hours are:

Tuesdays - Saturdays : 9.30 am - 5.00 pm
Sundays, Mondays & Public Holidays : Rest

Fees are complimentary (free-of-charge) until further notice. Meanwhile, free-will donation is appreciated. Thank you for helping us continue to offer affordable and accessible counselling to anyone in need. 

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Full Name *
Are you enquiring for yourself? *
If No, state other person's name, relationship and other details below
Age *
Gender *
Occupation *
Marital Status *
Contact No. *
Email *
How did you find out about Family Life? *
If you are from FGA, please let us know here.
Counselling Type *
Which counselling type would you like to request for? If you are requesting to attend the sessions with someone else, please make sure that they have agreed to come in for counselling and have submitted their own request form as well.
Matters of Concern *
Have you previously undertaken any counselling or psychological treatment? *
If Yes, please indicate which year and place (If No, please indicate N/A) *
Availability for Counselling Session
Please let us know your preferred time slots. Do select more than one (1) time slot so we can better match you with your counsellor's availability.

Our Saturday slots are already currently fully booked, so try to choose weekday time slots. If you don't mind queuing for the next available slot on Saturdays, you may still choose Saturday time slots and we will add you to our waiting list. 

  1. If you are filling this form from your mobile phone or tablet, be sure to swipe to the left to see all time options.
  2. This section is to let us know of your availability, and NOT for booking of an appointment.  
9.30 am - 11.00 am
11.00 am - 12.30 pm
12.30 pm - 2.00 pm
2.00 pm - 3.30 pm
3.30 pm - 5.00 pm
Which language do you prefer to use for the therapy?
You may choose as many languages as you feel comfortable using. Kindly note that we have limited counsellors who are able to fully engage in non-English languages.
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