MOH T&CM Evaluation Form

Malaysia Integrative Hypnotherapist Association (MIHA)

The MOH T&CM Evaluation is to submit the list of Practitioners and Premises by Non-Governmental Organization (NGOs) for the Purpose of Evaluation of Hypnotherapy Practices for Recognition under the Traditional and Complementary Medicine Act 2016 (Act 775).

"*" indicates required fields

Practitioner Details

Full Name per IC*

Phone Number*

Email*

Name of Premise / Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Premise*

Academic Qualification*

Basic Education Levels and Qualifications related to Hypnotherapy (Click + to add more)

Practicing Area*

Hypnotherapy only or other therapy method (Click + to add more)

Category of Profession - Mental Health*

Example: Medical Officer, Psychological Officer, Psychiatrist, Counsellor (Click + to add more)

Category of Profession - Non-Mental Health

(Click + to add more)

Comments

This field is for validation purposes and should be left unchanged.