Enquiry Form / 咨詢表格
In order to direct you to the most appropriate services, please fill out the form below. A staff member will call you after your information has been received.
請填寫以資料,以讓我們為你提供最合適的服務。收到資料後,我們的同事會跟你聯絡。
Name of person filling in form / 填表人姓名 *
Your answer
Relationship to child / 與學童關係 *
Your answer
Contact email address / 聯絡電郵 *
Your answer
Contact telephone number / 聯絡電話 *
Your answer
Child's Information / 學童資料
Name of child / 學童姓名
Your answer
Sex / 性別
Date of birth and age / 出生日期及年齡 *
Your answer
Current school & grade / 就讀學校及班級
Your answer
Languages spoken / 就用語言 *
Your answer
Diagnosis (if applicable) / 診斷 (如適用)
Your answer
Any existing therapy services / 請列出現正接受的治療
Your answer
Area of interest / 想查詢的服務 *
Required
Any additional questions or enquires? / 如有其他問題或查詢,請填寫下欄。
Your answer
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