Select Your Service

What type of support are you looking for? *Please selectIndividual Psychological CounsellingCouple CounsellingFamily CounsellingChild CounsellingAdolescent CounsellingCareer & Student CounsellingSpecial Needs & Developmental CounsellingStress & Anxiety ManagementTrauma & Grief CounsellingParenting Guidance & Parent CounsellingPsychological AssessmentCorporate Mental WellnessPsychoeducation / Mental Health AwarenessOther / Not Sure Next

Session Type

● Online Counselling Session

Sessions are conducted through a secure online communication platform. Details and access instructions will be provided after your appointment is confirmed.

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Choose Your Preferred Date & Time

Preferred date * Preferred time *Please selectMorning (9am–12pm)Afternoon (12pm–4pm)Evening (4pm–7pm) Back Next

Your Details

Full name * Date of birth / age * Mobile number * Email address * Preferred language * Country / location * Back Next

Emergency Contact

Please provide the details of a trusted person who may be contacted where necessary in accordance with applicable professional, ethical, and legal requirements.

Full name * Relationship to you * Telephone number * Back Next

What would you like support with?

Please briefly tell us what you would like support with. * Back Next

Previous / Current Support

Have you previously received psychological or counselling support? *Please selectYesNoPrefer not to say Are you currently receiving psychological or mental health support from another professional? *Please selectYesNoPrefer not to say Is there anything important you would like your counsellor to know before the session? * Back Next

Important Safety Information

Lumiora Psychological Centre's online appointment service is not an emergency or crisis-response service. If you are in immediate danger, experiencing a life-threatening emergency, or require urgent assistance, please contact the appropriate emergency service or seek immediate help in your location.

I understand that Lumiora's online counselling service is not an emergency service. *

Client Declaration

I confirm that the information I have provided is accurate to the best of my knowledge. * I understand that submitting this form is an appointment request and that my appointment is confirmed only after confirmation from Lumiora Psychological Centre. *

Terms & Conditions

Read Terms & Conditions

I have read and agree to the Terms & Conditions. * Back