We’re relocating to a new space at City Square Mall (B2-29A, 180 Kitchener Road, Singapore 208539) to make our services more accessible and convenient for you. Our current centre at NLB will close from 29 August 2025, and we’re excited to welcome you to our new home on 4 September 2025. Stay tuned for updates!

Counselling

Home - Counselling - General Enquiry/Appointment Form

Make an Appointment – General Enquiry/Appointment Form

All information collected through this form will be treated as confidential.

By filling up this form, it will help us expedite the process to meet your request.

You will be contacted within 3 working days. Our Client Services team will talk with you further about the appointment, fees and other administrative matters that you have queries about.

"*" indicates required fields

Type of Counselling Needed*

Enquirer's Particulars

This form is for Individual enquiries

Please select this if you are also the client

I am also the Client

Name*

Gender*

Local Contact Number*

Email*

Source of Referral (How did you come to know about our services?)*

Source of Referral (Others, please specify)*

Date of Show Attended*

Tracking Key/Transaction Number*

Enquirer's Particulars

This form is for Couple/Family enquiries.

Name*

Nationality*

Address*

Local Contact Number*

Email*

Gender*

Date of Birth*

Source of Referral (How did you come to know about our services?)*

Source of Referral (Others, please specify)*

Client's Particulars

Name*

Relationship to Enquirer*

Relationship to Enquirer (Others, please specify)*

Nationality*

For Foreigners, please specify your nationality.*

Gender*

Local Contact Number

Email*

Name of organisation*

Present/ Last Job Designation*

Job Designation*

Date of commencement with organisation*

Year of birth*

Marital Status*

Source of Referral (How did you come to know about our services?)*

Source of Referral (Others, please specify)*

Source of Referral (How did you come to know about our services?)*

Source of Referral (Others, please specify)*

Please briefly describe the challenge for which you are seeking professional counselling.*

Please attach the respective employment verification document(s)

Max. file size: 2 MB.

Date of Birth*

Total gross monthly income (inclusive of all freelance/part-time/contractual employment)*

Date of commencement with current agency

Note: First appointment will be fixed during office hours ONLY.

Preferred Language*

Preferred Language (Others, please specify)*

Message – Please briefly describe the challenge that you are seeking our service for.*

Please briefly describe the challenge that you are seeking professional counselling for.

Declaration*

By submitting my personal data here, I hereby agree and consent that Eagles Mediation & Counselling Centre (EMCC) may collect, store and process my personal data that I have provided for the purpose of administration.