Parenting Consultation Registration

Parenting Consultation Registration Form

Parent's Details

Name (Chinese)

Name (English)*

Identity Card No. (Example: 801205069657)*

Age*

Gender*

Occupation*

Email Address*

Mobile No. (Example: 0127777888)*

Introduced by

Residential Address

Address Line 1*

Address Line 2

Postcode*

City*

State*

Country*

Details of Child Who Receives Consultation

Name (Chinese)

Name (English)*

Identity Card No. (Example: 801205069657)*

Date of Birth*

Age (Please specify years and months)*

Gender*

School/Kindergarten*

Number of Siblings*

Birth Order Among Siblings*

Strength*

Weakness*

Child Preferred Communicating Language* Chinese English Others

If other language,please specify

Health Condition

Other Child's Details (1)

Name (Chinese)

Name as per IC (English)

Age (Please specify years and months)

Gender

Birth Order Among Siblings

Strength

Weakness

Hobby

Other Child's Details (2)

Name (Chinese)

Name as per IC (English)

Age (Please specify years and months)

Gender

Birth Order Among Siblings

Strength

Weakness

Hobby

Other Child's Details (3)

Name (Chinese)

Name as per IC (English)

Age (Please specify years and months)

Gender

Birth Order Among Siblings

Strength

Weakness

Hobby

Other Child's Details (4)

Name (Chinese)

Name as per IC (English)

Age (Please specify years and months)

Gender

Birth Order Among Siblings

Strength

Weakness

Hobby

Please Take Note

Please make sure to complete and provide detailed information about your child to ensure a smooth consultation process. This includes details about your child's siblings, school names, etc. Thank you for your cooperation.

Call/Whatsapp us for a quick assessment

+6019-2971431

It is common for most people to have a certain level of psychological problem. Either it was you or your loved ones, visit us for a quick assessment will be helpful before it causes more problems.

Address

E-03-22 IOI Boulevard, Jalan Kenari 5, Bandar Puchong Jaya, 47100 Puchong, Selangor, Malaysia.

Email

info@azon.my

Telephone

Existing/Registered Client Support Hotline
+6(011) 1431 0558

Child Learning & Development Assessment/
Psychological Service Appointment Booking Hotline
+6(019) 297 1431

Service/Event Inquiry，Non-Profit/Charity & Recommendation
+6(019) 231 7154

Certificates and Licenses

Version 4.4.2.2024.01

About Us

Understand the Types of Disorders

Professional Care

Life Education

Psychological Services

Online Psychological Services

Activities

Multimedia

Info Station

Online Forms

Call/Whatsapp us for a quick assessment

+6019-2971431

About Us

Understand the Types of Disorders

Professional Care

Life Education

Psychological Services

Online Psychological Services

Activities

Multimedia

Info Station

Online Forms

Call/Whatsapp us for a quick assessment +6019-2971431

Call/Whatsapp us for a quick assessment

+6019-2971431