个别辅导/咨商/心理治疗预约申请表
 Counselling/ Psychotherapy Application Form
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辅导中心欢迎你到C栋2楼与我们安排时间面谈。
Welcome to the Counselling Centre! Please visit us on the Block C (2nd floor) to schedule a counselling session with us.

辅导中心服务时间 Office Hours: 星期一至五 (Monday - Friday) ，8:30 am - 5:00pm

如何去总院的辅导中心短片 Getting to NEUC Counselling Centre (Video):
NEUC Counselling Centre Location Video
若你想要线上申请，留下你的资料，我们会尽快与你联系。
If you would like to apply online, please leave your information and we will get in touch with you as soon as possible.

请接听我们的电话，以便我们可以跟你联系。
另外，我们会以电邮(counselling@newera.edu.my)作为联系方式，请留意我们的电邮。

Please answer our phone call so we can reach you. Additionally, we will also be using email (counselling@newera.edu.my) as a means of communication, so please check your email regularly.

我们的电话号码如下：
Our phone numbers are as follow:
  1. 03-8740 6392 (Main Line)
  2. 03-8210 3709 (MainLine)
  3. 03-8740 4392
  4. 03-8741 8192
  5. 03-8741 4923
  6. 03-8741 4924
  7. 03-8740 6925
  8. 03-8737 9292
姓名 (中)
Chinese Name
姓名(英) *
English Name
科系 / 部门 *
Course enrolled / Department
学号（如有） Student ID (if you have)
联络电话 *
Tel no.
E-mail *
想要会谈的主题（可以重复选择）
Topics for counselling (you may select multiple)
 *
Required
首选辅导语言 Preferred Language *
Required
备注 Remarks
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