Understanding your requirements for a therapist
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. If you're not sure on some of the questions or answers and would like to contact us, you can reach us at +6014-7644283 or email us at inospacetherapyrooms@gmail.com. Thank you.
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Your name *
Phone number *
E-mail *
Which type of mental health professional are you looking for?
If you already know which professional you'd like to meet or enquire about, kindly choose below (more than one responses is possible)
If you don't have any particular therapist in mind yet, what type of therapy are you looking for?
How old are you?
What language would you prefer the session to be conducted in?
Clear selection
Are there specific concerns you would like to discuss with your therapist?
Submit
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