Get started – General form

Please Complete

Parent/Carer Details

Client Details

Reason for Therapy

(Please include relevant background, trauma history if known, current behaviours or symptoms, and
purpose of therapy)

Type of Support Requested

Individual Psychotherapy / CounsellingCouples CounsellingParenting SupportFamily Sessions

Preferred Delivery

In-person at clinicTelehealthFlexible

Attach supporting documentation

Mental Health Care Plan (required for Medicare Rebate)

Previous assessments/reports

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