疗程反馈表格 Session Feedback Form OM SPACE THERAPY CENTRE "*" indicates required fields 客户个人资料 Client Information Details姓名 Name Per IC / ID* Full Name 电话号码 Phone Number*电邮 Email* 疗程类型 Type of Therapy Session*心灵咨询疗程 Consultation Session催眠疗程 Hypnotherapy Session心理咨询疗程 Psychotherapy Session心理评估 Psychological Assessment认知行为治疗 Cognitive Behavioural Therapy婚姻咨询 Marriage Therapy家庭咨询 Family Therapy事业咨询 Career Coaching治疗中心地点 Therapy Centre Address*Om Space Therapy Centre, Petaling Jaya客户反馈 Client Session Feedback整体来说，您对疗程的评分 Your overall rating to the therapy session*5 Stars4 Stars3 Stars2 Stars1 Star您对治疗师/教练的评分 Your overall rating to the Certified Practitioner/Coach*5 Stars4 Stars3 Stars2 Stars1 Star您对服务顾问安排的评分 Your overall rating to the Customer Service Consultant*5 Stars4 Stars3 Stars2 Stars1 Star请与我们分享您对疗程的心得与评价*Kindly share with us your thought and feedback to the session.有什么话想对心理治疗师/教练说？* Any thought to share to your Certified Practitioner/Coach?整体来说，Om Space Therapy Centre 有什么需要进步的地方？*Is there any suggestion for Om Space Therapy Centre to improve?为了帮助更多人能与您一样，走向正能量，请问您是否愿意让我们分享您的反馈（匿名分享）？(个人资料、疗程过程将会完全保密 )*In order to help more people to move towards positive life like you, would you like to let us share your feedback (anonymous sharing)? (Client's personal information and conversation shall be private and confidential.) 是 Yes 否 No 心理治疗师 / 教练 Certified Practitioner / Coach*Cmt. Wendy FooCht. Rachel FooCht. Irene TanCht. Justine NgMr. Kok MengMsc. Meisi CheongSupporting Document (If Any) Drop files here or Select files Max. file size: 256 MB. PhoneThis field is for validation purposes and should be left unchanged.
