STUDENT PROMO: First Intake Session with Carmen (75-90 mins) RM200

2:30 am - 4:00 am

Sat, July 5, 2025

2:30 am - 4:00 am, Sat, 7/5/2025

We'll meet on a web conference

Hi Student, welcome to your first step toward healing and growth! If this is your first therapy session with us, please select the First Int... more

First Name

Last Name

Name of Faculty at University

Student ID

Age

Date of Birth (DD/MM/YYYY)

NRIC / Passport Number

Gender

MaleFemale

Current Address

Contact Number

Nationality

Preferred Language

EnglishMandarinCantonese

Emergency Contact 1 (Name, Relationship to you, Phone Number)

(E.g., Thomas, Spouse, +60123456789)

Emergency Contact 2 (Name, Relationship to you, Phone Number)

(Eg. Mary, mother, +60123456789)

Have you had any thoughts of ending your life?

Have you considered or made plans on how you might end your life? Do you intend to carry out this plan?

Reschedule and Cancellation Policy (https://mindwavepsy.com/terms-and-conditions)

I have read and agreed to the 24-hour notice policy for rescheduling and cancellation (as stated in 'SECTION 3' of the Terms and Conditions)

Terms & Conditions (https://mindwavepsy.com/terms-and-conditions)

I have read and agreed to the Terms and Conditions, including confidentiality, risks, cancellation policy, payment, and client rights.

Age Requirement

I hereby confirm that I am 16 years old or above.

Student ID Verification (We will contact you via WhatsApp)

I hereby grant permission to provide a copy of my student ID as verification for the 'Exclusive University Students' Promo'

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