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Note:
Due to overwhelming caseload, we will not accept any new cases until February 2023.
Thank you for your understanding.
Due to an overwhelming caseload, we will not accept any new cases until February 2023.
Please fill up the form below and our staff will get in touch with you within 5 working days.
Our fee ranges from $100 to $120 per counselling session. A subsidised rate is available for individuals with a Household Per Capita Monthly Income below $2,800.
Salutation
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Mr
Mrs
Miss
Ms
Mdm
Dr
Full Name
Contact No.
E-mail
Date of Birth (DD/MM/YY)
Gender
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Male
Female
Race
Chinese
Malay
Indian
Caucasian
Eurasian
Other...
Religion
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Catholic
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Marital Status
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Married
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No. of Years Married
No. of Children
Highest Education Level
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Primary / Elementary
Secondary / High School
ITE / Technical / Vocational
Pre-U / College
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Post-graduate
Occupation
Monthly Income ($)
From 0 to 1500
From 1501 to 3000
From 3001 to 4500
From 4501 to 6000
6000 Onwards
Preferred Language for Counselling
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English
Chinese
Counselling Needs
Emotional Management
Family Issues
Inter-personal Relationship
Marital Relationship
Parenting Issues
Pre-marital Relationship
Marital Infidelity
Other...
Have you received counselling or other mental health treatment?
Yes
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If yes, please specify
How do you know about our service?
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Other...
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By submitting this form, I understand that the information provided above will only be used to maintain or enhance the relationship with TOUCH. TOUCH is committed to
maintain
the confidentiality of the information provided by me and undertakes to not divulge to any third party without my prior consent. I have read and understood the TOUCH Privacy Policy as stated on
https://www.touch.org.sg/privacy-policy
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