预约表格 Appointment Request Form
这个表格只是处理博爱总会的预约。若要安排其他分会的预约请直接拨电给该分会。谢谢
This online appointment form only made for MAIN HQ. Please call to our branch directly if you want to make appointment at other branch. Thank you.

槟城分会 Penang Branch (请直接致电 Please call to 04-2280 709 / 017- 499 4236)
新山分会 Johor Branch (请直接致电 Please call to 07-357 9195 / 016 - 275 9195)
马六甲分会 Malacca Branch (请直接致电 Please call to 06-288 9026)
亚庇分会 Sabah KK Branch (请直接致电 Please call to 088-252 357)
怡保分会 Ipoh Branch (请直接致电 Please directly call to 018-913 4833)
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IMPORTANT NOTICE
本中心确保不会利用您的个人资料进行任何的交易或向任何第三方泄露您的信息。
所提供的辅导服务拥有固定的费用。
预约的确认将在1至3个工作天内，以WhatsApp: 011-6530 9722 或电邮方式发出。
我们将尽可能的根据您的选项做出合适的安排。
如您有任何问题，请在博爱工作时间与本中心联系，03-7785 5955。谢谢。
Please note that we do not rent or sell your information to any third parties!
Service provided with a standard fee and charges.
Appointment will be confirmed in 1-3 working day by WhatsApp: 011-65309722 / email.
We will try our best in meeting your preferences, should there be any discrepancies please feel free to contact us at 03-7785 5955 on our working hour!
姓名 Name (As per I/C) *
电邮 Your E-mail *
联络号码 Your Phone number *
为谁安排预约？ The appointment is for? *
性别 Gender *
年龄 Age *
出生日期 date of birth *
你需要哪一种类的辅导服务？ You would like to request for which type of counselling? *
Required
实体辅导服务须知 Note on Counselling service in Centre
1. 高风险个案和家属鼓励戴口罩。High Risk clients and family member are encouraged to wear mask.
2. 鼓励使用消毒液洗手。Use hand sanitizer.
3. 倘若个案的身体不适，鼓励您致电更改预约或是改为线上视讯辅导。If you are feeling unwell, please call up for appointment reschedule or change to online Video-call counselling.
线上视讯辅导服务须知 Note on Online Video Call Counselling service
1. 具备稳定的网络和安静的空间。Stable internet connection and quiet surrounding.
2. 建议你戴耳机。It would be good if using earphone
3. 获取线上链接与辅导员联系。Obtain link that connect to counsellor.
4. 15分钟前在线上做准备。Prepare to online 15 minutes before session time.
4. 必须允许麦克风和摄像头开启 。Must enable camera and audio/mic.
5. 切记：禁止在辅导过程中录音或录影。 Remember: Voice or video recording are prohibited.
语言首项 （可以多项选择）Preferred language that best to express oneself (can select more than 1) *
Required
你所面对的问题 In presenting issue *
Required
简单描述您所面对的问题，若您无法找到以上选项 Briefly describe your presenting issue if you are unable to find the description above
前来接受辅导的个案有自杀念头吗？ Do the person seeking counselling have suicidal thoughts? *
前来接受辅导的个案有吃药吗？ Do the person seeking counselling under medication? *
日期首选 Preferred Date *
时间首选 Preferred Time *
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