Appointment Form
Make An Appointment
Please use the form below to request an appointment for counselling services. Completing all fields will help us match you with the best counsellor for you.
If you would prefer to answer these questions face to face, please email director@livingwellcambodia.org
For all other inquiries, email info@livingwellcambodia.org.
CONFIDENTIALITY/HOW WE USE YOUR INFORMATION
The information you provide on this form is only accessed by the intake personnel at Living Well, and by the counsellor they ask to work with you. We’re bound by confidentiality polices that prevent disclosure of any client information to external persons of organisations except under certain circumstances of imminent risk of harm, or awareness of a serious offence. Our full Confidentiality/Safeguarding Policy is available upon request. Should further information be required, or you wish to discuss sensitive information without entering it into our Request for Services form, please contact director@livingwellcambodia.org.