Name of enquirer 询问者姓名
*
First Name
Last Name
Enquirer’s phone number 询问者联系号码
*
-
Area Code
Phone Number
Enquirer's Email 讯问者电邮
example@example.com
Enquirer’s address 讯问者地址
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How do you know us? 您是如何知道我们?
*
Google 谷歌
Facebook adv 脸书广告
Friends 朋友
Gov hospital 政府医院
Private hospital 私人医院
Name of Hospital/Doctor 医院名称/医生姓名
Enquirer's preference language 询问者优先语言
*
English 英文
Chinese 中文
Malay 马来文
Relationship to Child 询问者与孩子的关系
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Mummy 母亲
Daddy 父亲
Grandma 婆婆
Grandpa 公公
Children's full name 孩童姓名
*
Children's Date of birth (DD/MM/YYYY) 孩童出生日期
*
Children's diagnosis (if any/suspected) 孩童诊断(如有)
Children's preference language 孩童优先语言
*
English 英文
Chinese 中文
Malay 马来文
How you like us to contact you? 您想我们使用什么方式与您联系。
*
Phone Call 电话联系
WhatsApp
Email 电邮
Enquiry for 您想询问:
*
JB Preschool Program (Infant Care / Toddler Care) 新山幼儿园课程 (2个月 - 3岁)
JB Preschool Program (3 years old - 6 years old) 新山幼儿园课程 (3岁 - 6岁)
JB EIP (Child Development Program/School Readiness Program) 新山早期介入课程
JB Occupational Therapy 职能治疗 (新山区)
JB Speech Therapy 语言治疗 (新山区)
JB Play Therapy 游戏治疗 (新山区)
JB Clinical Psychologist 心理治疗 (新山区)
Ipoh Preschool Program (Toddler Care) 怡保幼儿园课程 (18个月 - 3岁)
Ipoh Preschool Program (3 years old - 6 years old) 怡保幼儿园课程 (3岁 - 6岁)
Ipoh EIP (Child Development Program/School Readiness Program) 怡保早期介入课程(怡保区)
Ipoh Occupational Therapy 职能治疗 (怡保区)
Ipoh Speech Therapy 语言治疗 (怡保区)
KL Occupational Therapy 职能治疗 (吉隆坡区)
KL Speech Therapy 语言治疗 (吉隆坡区)
KL EIP (Child Development Program/School Readiness Program) 吉隆坡早期介入课程(吉隆坡区)
Puchong EIP (Child Development Program/School Readiness Program) 蒲种早期介入课程(雪州区)
Puchong Occupational Therapy 职能治疗 (雪州区)
Puchong Aroma Therapy芳香疗法(雪州区)
Puchong Speech Therapy 语言治疗 (雪州区)
Puchong One to one Education Support一对一辅助教育(雪州区)
Parent's concerns 父母关注的问题
Let us know your concern. We will assist and support you from here. The more detail information, the more we can support. Thank you. 请让我们知道您的问题和您想要我们协助您的部分。您提供的资料越多,我们更能有效率的协助您。谢谢
Top 3 concerns 首三个最重要的问题
*
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This section is used by Joyous Kiddy Team only.
Person in charge
Date of first contact
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Month
-
Day
Year
Date
Contact Method
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Facebook Message
Email
Action Plan after contact
Final Plan
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