Session Booking Enquiry Form

Session Booking Enquiry Form

Once we receive the filed form, we will contact you shortly to confirm your appointment (WhatsApp +65 86284685 | email clientcare@rogerianpsychology.com).
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Country CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Client(s)*
Session Medium*

No preferenceFace-to-faceOnline

Pricing per hour (discount packages avail)	Individual	Couples
Intern	Free	Free
Counselling / Psychological Associate	$80	$130
Professional Counsellor	$160	$210
Psychologist	$180	$240
Senior Counsellor	$220	$280
Senior Psychologist	$220	$280

Preferred Therapist
Discount / Promotion Code (if applicable)
Preferred Appointment (Working hours: Monday to Saturday: 9am to 9pm only)*

MonthDayYear
Date
Hour MinutesAM/PM Option
Counselling/Therapy Session (Select One)*
prevnext( X )
Individual Therapy (Professional Counsellor)
$160.00SGD Quantity



Couples Therapy (Professional Counsellor)
$210.00SGD Quantity



Individual Therapy (Psychologist)
60 minute session

$180.00SGD Quantity



Couples Therapy (Psychologist)
60 minute couples session

$240.00SGD Quantity



Individual Therapy (Senior Counsellor)
60 minute session

$200.00SGD Quantity



Couples Therapy (Senior Counsellor)
60 minute couples session

$250.00SGD Quantity



Individual Therapy (Senior Psychologist)
60 minute session with psychologist (senior)

$220.00SGD Quantity



Couples Therapy (Senior Psychologist)
60 minute session with psychologist (senior)

$280.00SGD Quantity



Hypnotherapy
90 minute session with a Hypnotherapist

$500.00SGD Quantity



Paypal Fees
$20.00SGD



Subtotal

$0.00SGD

Tax

$0.00SGD

Total

$0.00SGD
Please share your concerns here?
Terms & Conditions:

1. Cancellation / reschedule with less than 24 hours before session starts will be chargeable.

2. No show for session will result in payment being forfeited.
Should be Empty: