Client-Matching
Please fill out this short questionnaire to provide some general and anonymous background about you and the issues you'd like to deal with in therapy. It would help us match you with the most suitable therapist for you. Your answers will also give this counsellor a good starting point in getting to know you. 

NOTE: If you have submitted a request before, please do not resubmit. Email joy@aspacebetween.com.sg instead, thank you!
Email *
Hello! What is your first name? *
I would like to connect with... *
Please let us know if you have a specific therapist in mind. Please note that some therapists listed may have a full caseload and are not currently accepting new clients (Jen Marinas and Kelly Chan are currently not accepting new clients; Danica has moved out of Singapore; Allison is only conducting virtual sessions at the moment). Damian Banwell is not taking on new clients and he is uncontactable. This list is regularly updated.
Required
Which type of mental health professional are you looking for? *
At A Space Between, we have a range of mental health professionals available to assist you. By selecting the right mental health provider, you can take charge of any challenges in your life and move towards improved well-being."
What is your contact number? *
How many therapists would you like to speak with? *
Please select a preferred number of therapists to be shortlisted for you to speak with. We understand that having too many options can be overwhelming for some clients. Rest assured that your chosen number will be respected, and please ensure you provide accurate contact information for further communication.
What type of counselling are you looking for? *
Would you prefer your regular therapy sessions to be held online or in-person? *
How old are you? *
(Age of the individual receiving treatment - if your child is the one receiving treatment, please indicate their age)
What is your gender? *
What are your pronouns? *
How do you identify? *
Would you like to be matched with a therapist who specialises in LGBTQIA+ issues? *
If English is not your main language, what language would you prefer the session to be conducted in?
Are there specific concerns you would like to discuss with your therapist? *
(Select all that apply.)
Required
Have you ever been in therapy or counselling before? *
Why are you seeking therapy at this time? *
I prefer a/an... *
Select all that apply. PLEASE NOTE: If your preferred criteria, such as age or specialisation, are not available, we will match you with the next best-suited therapist based on your needs and preferences.
Required
Does the sex or gender of your therapist matter? *
Do you consider yourself to be religious? *
Does the religion of your therapist matter? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of A Space Between Pte. Ltd.. Report Abuse
Google Forms