ECG Counselling Request Form
Please fill in this form to make an appointment with the ECG Counsellor (Mr. Faizal).
For self-referrals, students can fill in and submit this form personally.

Please note that your form teacher will be informed of your booked session.

For referred cases, teachers are to fill in and submit this form with your student's particulars.

Email address *
Select the source of this appointment request. *
Name of Student *
Your answer
Gender *
Level *
Stream *
Class *
Your answer
Email (Confirmed date, time and venue of session will be sent to this email address for self referrals.) *
Your answer
Mobile number *
Your answer
Counselling Session *
Name of Student's Form Teacher *
Your answer
Areas of Discussion with ECG Counsellor (You may choose more than one option.) *
Required
Please provide any other information that you will like the ECG Counsellor to know before the session. *
Your answer
Date of Consultation *
Preferred time slots for counselling session. Please note that the ECG Counsellor will only be at Westwood on Mondays during term time. You can choose more than one option or suggest a time-slot that does not affect your lessons. *
Required
A copy of your responses will be emailed to the address you provided.
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