Rogerian Practicum Clinic - Free Counselling

Rogerian Practicum Clinic:

If you like what we do, please 'like' and 'share' our Facebook and Instagram pages to show us support! WhatsApp: +65 86284685, Email: clientcare@rogerianpsychology.com.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

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Postal / Zip Code
Phone Number *
Which of the following can we contact you on (Check all that applies)? *

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Your WhatsApp/Viber/WeChat/Facebook/Other ID *
E-mail *
example@example.com
Profession: *
Income Range: *
Preferred Appointment Time (Working Hours: Monday to Saturday: 9am to 9pm; Sunday: by Appointment Only) *

Month Day Year
Date
Hour Minutes AM/PM Option
Counselling Medium
How did you hear about us? *
Other *
Tell us about your counselling concerns:
Will you be willing to recommend us?

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**By using this free service provided by Rogerian Practicum Clinic, you agree to abide by the following Terms & Conditions:
1. You are aware and accept that the free counselling services are provided by interns at Rogerian Practicum Clinic.
2. You agree to indemnify Rogerian Psychology Singapore of any damages: material or non-material that you may suffer either directly or indirectly from the counselling service.
3. Any no show on your end without a valid medical certificate would mean that you are liable to penalize and will need to compensate Rogerian Practicum Clinic for the amount of S$50 for irresponsibly making booking and not turning up for the free session.
4. You are required to like and share our facebook, instagram, and google page to show support to our initiatives.
5. By clicking submit, you agree to be binded by the above terms and conditions.
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Rogerian Practicum Clinic: