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Client Name*

First Last

Client Email*

Client Phone*

Date of Birth*

Are you a new/existing client?*

New Client

Existing Client

Name of Psychologist*

Current Medicare Card*

Yes

Do you have a mental health treatment plan?*

Yes

GP Provider Number*

The GP provider number is located either on your referral letter and/or your Mental Health Treatment Plan beneath/next to your referring GP’s name. If you cannot locate the GP Provider number, please contact the GP Clinic Reception for the information.

GP Name*

Unfortunately, we are unable to progress your booking

To continue with your booking, you will need a current Medicare Card

Please feel free to visit our Frequently Asked Questions Here or Contact Us Here

Unfortunately, we are unable to progress your booking

To continue with your booking, you will need a current Mental Health Treatment Plan

Please feel free to visit our Frequently Asked Questions Here or Contact Us Here

Kindly note that appointment booking is based on Australian Western Standard Time (AWST).

Please feel free to use this link to calculate the time difference before proceeding.

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