Informed Consent Form

在疗程进行之前,Om Space Wellness Centre 的客户需签署疗程同意书以达成双方承认并同意Om Space Wellness Centre疗程制度。疗程同意书制度与通知如下:


我特此完全同意并接受 Om Space Wellness Centre 心理治疗师的治疗疗程与相关制度。

  1. 我了解通过疗程获得的结果是因人而异的,并且没有特定的结果保证。
  2. 我了解疗程不能替代医学治疗,也了解Om Space治疗师不开立药物处方,或给予任何药物治疗。
  3. 我了解在某些情况下,治疗师可能需要触碰手,手腕,手臂,肩膀或额头的部分,以帮助我建立更放松的状态,我特此同意治疗师的这种抚触。
  4. 我已尽我所能参加每次的疗程,并按照治疗师的要求准确提供了相关信息。
  5. 我了解我在疗程中所说的事情会得到专业的保密,没有经过我的口头或书面同意,治疗师不会告知他人相关信息。我也了解专业保密的限制,如果我的谈话内容涉及自我伤害、伤害他人或涉及司法相关法令(儿童虐待、家庭暴力、性侵害等)时,我同意治疗师通知我的家人或相关机构,以便保护我及他人的安全。未满18岁的客户也同样会受到相关的隐私保护。
  6. 我了解我可以随时询问关于评估或治疗的问题,包括评估或治疗的程序、疗程的场所与时间、费用及付款方式、保密的限制、治疗的效果与限制,以及社区资源等。


  1. 通过提交此表格,您特此同意Om Space Wellness Centre可以收集,获取,存储和处理您在此表格中提供的个人数据,以便接收来自Om Space Wellness Centre 的更新,服务,新闻,促销和营销邮件和/或资讯。您特此同意Om Space Wellness Centre存储和处理您的个人数据;或在马来西亚法律要求或出于法律目的的情况下,向相关政府机构或第三方单位披露您的个人数据。
  2. 如果您希望请求访问或纠正您的个人数据或撤回/限制您的同意,您可以随时将您的请求发送给Om Space Wellness Centre。您的请求应受任何适用的法律限制、条件和合理期限的约束。
  3. 另请注意,Om Space Wellness Centre可能会不时要求您提供最新的个人信息 。通过向我们提供您的个人信息或继续与Om SpaceWellness Centre接洽,我们将视为您已同意处理此类数据。
  4. 为免生疑问,个人数据包括《2010年个人数据保护法》中定义的所有数据,包括您在此表格中向Om Space Wellness Centre披露的所有数据。


  1. 退货和退款政策适用于Om Space Wellness Centre以Om Space Sdn. Bhd品牌提供的所有产品和服务。
  2. Om Space Wellness Centre已尽最大努力确保产品和服务得到正确履行。如果交付的产品和服务有任何差异,并且客户预想进行退货和退款,请在支付金额的五(5)天内联系我们的客户服务热线通知我们。
  3. 在任何情况下,所有已完成的治疗疗程均不予退款。
  4. Om Space Wellness Centre应保留预付款(第一笔支付款项),以扣除客户签订的的后续治疗与疗程。
  5. 所有的疗程配套有效期为18个月,客户允许更换或转接其他治疗疗程配套,并根据不同的治疗疗程价格支付额外差价或费用。
  6. 客户承认并同意所有签购的治疗疗程与配套不得要求退款,客户进一步同意,这是我们本协议的基本条款。


Before the treatment begins, Om Space Wellness Centre’s clients are required to agree and sign the Treatment Informed Consent Form to reach mutual acceptance and agreement to the Om Space Wellness Centre’s policies. The clauses of informed consent form for treatment are as follows:

Informed Consent Form

I hereby fully agree to and accept the treatment provided by the practitioner and policies in Om Space Wellness Centre.

  1. I understand that the results obtained through the treatment may be vary for each individual and no specific results can be guaranteed.
  2. I understand that the treatment is not a substitute for medical treatment, and I understand that Om Space Wellness Centre’s practitioners do not prescribe medications or give any medications.
  3. I understand that in some circumstances it may be necessary for the practitioner to respectfully touch me on the hand, wrist, arms, shoulder or forehead as a means of helping me establish a beneficial state of relaxation, I hereby consent to such touching by the practitioner.
  4. I have agreed to participate in each session to the best of my ability and accurately provided my background information as requested by the practitioner.
  5. I understand that the information I provided during the treatment will be kept confidential professionally and the practitioner will not disclose the information to others without my oral or written consent. I am also aware of the limitations of professional confidentiality, if my information or conversation involves self-harm, harm to others, or involves a judicial-related statute (child abuse, domestic violence, sexual assault, etc.), I agree that the practitioner may notify my family or related agency in order to protect me and others. Clients who are under the age of 18 are also subject to the associated privacy protections.
  6. I understand that I can ask questions about the assessment or treatment at any time, including the procedure for the assessment or treatment, the location and timing of the treatment, the cost and payment method, the restrictions on confidentiality, the effects and limitations of the treatment, and the resources of the community.

Personal Data Protection Notice

  1. By submitting this Form, you hereby agree that Om Space Wellness Centre may collect, obtain, store and process your personal data that you provide in this form for the purpose of receiving updates, services, news, promotional and marketing mails and/or materials from Om Space Wellness Centre. You hereby give your consent to Om Space Wellness Centre to store and process your Personal Data; or disclose your Personal data to the relevant governmental authorities or third parties where required by the law of Malaysia or for legal purposes.
  2. If you wish to request access to or to rectify your Personal Data or withdraw/limit your consent, you may at any time send your request to Om Space Wellness Centre. Your request shall be subject to any applicable legal restrictions, conditions and a reasonable time period.
  3. Please also note that from time to time, Om Space Wellness Centre may request for latest Personal Information from you. By providing us with your Personal Information or continuing to communicate with Om Space Wellness Centre, we shall regard that you have consented to the processing of such data.
  4. For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all data you had disclosed to Om Space Wellness Centre in this Form.

Return and Refund Policy

  1. The Return and Refund policy shall be applicable to all products and services offered by Om Space Wellness Centre under the brand of Om Space Sdn. Bhd.
  2. Om Space Wellness Centre shall use its best efforts to ensure that products and services are correctly fulfilled. Should there be any discrepancy of products and services delivered and the customer would proceed for return and refund, please notify us by contacting our Customer Service Careline within five (5) days upon paying the amount. 
  3. All fulfilled treatment sessions are strictly non-refundable in any kind of circumstances.
  4. Om Space Wellness Centre shall keep the upfront payment (First payment) in deduction of subsequent treatment session that subscribed by the clients.
  5. The session packages are valid for 18 months, clients are allowed to exchange or transfer the extra treatment sessions with other type of treatment sessions, additional fee may applied by following the particular treatment price list.
  6. By signing up for any treatment session and/or package, the client acknowledges and agrees that client shall not claim any refund by strict compliance. The client further acknowledged that this is an essential term of this agreement which we rely on.