Booking Form (2) – Teman Malaysia

Teman Malaysia | Booking Form

This booking form consists of 4 sections:

Section 1: Details of the client and the service recipient
Section 2: Details of the service
Section 3: Client's Permission and Consent
Section 4: Payment Details

Please fill in the required details. For more information about Teman Malaysia and our service, kindly visit https://www.temanmalaysia.com. We look forward to assisting you with our service, thank you!

Details of the Client and the Service Recipient

It is highly encouraged to value transparency throughout this section. The information given will be communicated to the Temanion of this service. Please ensure to give the information as detail as possible.

Full Name of the Client (as per NRIC)*

Client is referred to the person who is in charge of this booking and the payment for this service.

Email*

Phone Number of the Client (01x-xxxxxxxx)*

This Service is for ...*

My Self

My Spouse

My Mother / Mother In-Law

My Father / Father In-Law

My Relative

Others

Full Name of Service Recipient (As per NRIC)*

Phone Number of the Service Recipient (01x-xxxxxxxx)*

Nickname Name of Service Recipient (used in Daily Basis)*

This is to be used by Temanion to interact with the Service Recipient

Age of Service Recipient (years)*

Gender of Service Recipient*

Male

Female

Service Recipient Range of Height (in cm)*

Service Recipient Range of Weight (in kg)*

Health Condition of Service Recipient*

Please include every single details as possible. It is highly encouraged to be transparent with the information given as it is to ensure safety of the Service Recipient and the Temanion throughout the service.

Please State Other Health Condition of the Service Recipient*

Dependency of Service Recipient*

Independent

Semi-dependent

Wheelchair-bound

Bedridden

Client's Permission and Consent

I hereby grant Teman Malaysia (the “Company”) the right and permission to use photographs and/or video recordings of me and/or the elderly in my care during the service period on the Company’s websites, publications, promotional flyers, communication materials, derivative works, or for any other similar purposes. I understand and agree that I and/or the elderly in my care may be identified by name and/or title in printed, Internet or broadcast information that might accompany the said photographs and/or video recordings. I agree that all such image files, video and audio recordings, and any reproductions thereof, shall remain the property of the Company. I hereby warrant that I am competent to contract in my own name and that this release is binding on me, the elderly in my care and/or personal representatives.

Yes, I allow.

No, I do not allow.

Our Customer service will contact you back after you submit this form. Thank you.

Total

Bahasa Pilihan / Language Preference*
- Bahasa Malaysia
- English

Nama*
Name*
Cara untuk dihubungi*
- Telefon
- Email
- WhatsApp
Your Favorite Communication Platform*
- Call
- Email
- WhatsApp
Nombor Telefon*
Phone Number*
Email*
Nombor WhatsApp*
WhatsApp Number*

Nota atau komen tambahan? (Jika ada)
Notes or Comments? (If any)

Teman Malaysia | Booking Form

Details of the Client and the Service Recipient

Details of the Service

Client's Permission and Consent

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