Confidential Intake Form – Psychology

    *Eligibility: Please note that we are currently not taking referral for clients under the age of 14 and we can only accept NDIS referrals that are self-managed. Sorry for any inconveniences.

    Please save our clinic phone number 9739 6409 into your phone, under BDHH , so you know it is us, when we call.

    Thank you for enquiring with us and requesting this intake form. BDHH wants to ensure we can provide the most suitable care for you regarding this enquiry, and if not with us we will endeavour to provide a suitable referral. As such, our policy is to follow up enquiries if we do not hear back from you to ensure proper duty of care is taken. Our intake worker, Tash may follow up enquiries up to 4 times via email and phone call to ensure your enquiry is completed. If you decide at any point that you no longer wish to access our service then please let us know so we can close your enquiry as these services are in demand at this time.


    Are you aware of another family member currently consulting with a Psychologist at BDHH? Yes/No

    (We ask this question to avoid any potential client conflict and to ensure you receive the best psychological care possible.)

    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