Please fill up the form below and our staff will get in touch with you.

Race
Religion
Monthly Income ($)
Counselling Needs
Have you received counselling or other mental health treatment?
How do you know about our service?
By submitting this form, I understand that the information provided above will only be used to maintain or enhance the relationship with TOUCH. TOUCH is committed to maintain the confidentiality of the information provided by me and undertakes to not divulge to any third party without my prior consent.