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Type of business

Please enter in the details of all mental health staff at this practice.

The questions on gender and religion is for Relate Malaysia's record keeping purposes. However, some clients may be more comfortable with mental health professionals of certain gender and religion. Please indicate if you are willing to display information about gender and religion. 
      Name Gender Religion Profession Highest degree University where highest degree was obtained Number of years in practice Cost per session Specialization if any (population, mental illness or type of therapy) List down any membership at professional organization(s)

Is there a waiting list?

Are you willing to display information about gender and religion under your business listing?

All listed staff above have complied with the legal requirements of their respective professions, or in the case of clinical psychologists, will comply with the legal requirements of the profession when the Allied Health Act is implemented.

By indicating yes below, you agree that may collect, use and disclose your personal data, as provided in this application form, or (if applicable) obtained by our organisation as a result of your membership, to be listed on Relate Malaysia, in accordance with the Personal Data Protection Act 2010 (

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