New client enquiries Client Name * First Name Last Name Referrer Name (If applicable) First Name Last Name Date of birth * MM DD YYYY Phone * (###) ### #### Email * Service delivery preference In-person Online Therapy How are you planning to pay for sessions * Privately paying NDIS Other Do you have a mental health care plan referral? * Please note that a referral is not required to book an appointment, however to receive rebates from Medicare we require a valid mental health care plan referral from your GP. Yes No Your enquiry * Please include your reason for seeking support (as much detail as you feel comfortable sharing), and any other information you would like us to know or questions you might have. Thank you, our admin team will be in in touch with you shortly
