Registration

Please follow the steps below to register

Registration Form

Full Name

Mobile Number

Age

Identification Card Number/Passport Number

Address

City

Postcode

State

Job Title

Education Level

Race

Religion

Status

Which issues are you struggling with?

Lack of motivation Financial constraints Marriage Mental health Motherhood Family matters Abusive relationship In-laws

Have you been referred to / are undergoing / have undergone a psychiatric treatment?

If yes, when was your last referral or last treatment session?

Please state your questions for the counsellor. This will help us to understand and help you with your concerns and challenges better

Preferred language

Bahasa Malaysia English (limited seats)

Preferred Timing

Wednesday: 12:30 - 1:30 PM Sunday: 9:00 - 10:00 PM

Disclaimer

As part of this agreement, you consent to Sisterhood and Mercy Mission Malaysia holding and processing data relating to the service being provided for legal, personnel, administrative and management purposes. Data will be managed in line with the requirements of the Data Protection Act 1998.