Confidential Intake Form – Psychology

    *Eligibility: Please note that we are currently not taking referral for clients under the age of 18 and we can only accept NDIS referrals that are self-managed. Sorry for any inconveniences.


    Have you seen a Psychologist before?

    Have you been diagnosed with a Mental Health issue in the past?

    Do you currently have anyone else involved in treating this issue?

    Have you ever been hospitalised for psychological reasons?

    Do you have any outstanding legal issues related to seeing a Psychologist?

    (e.g. child custody/child protection hearing, criminal cases, reports for legal reasons (e.g. Gun licenses etc.))

    Intended Funding Source

    Please indicate your desired preference of treatment modality

    Face to FaceTelephoneVideo conference/Zoom

    Please indicate if you require a particular day or time (please note we may not be able to accommodate)

    After HoursParticular day