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Please complete the form below to help me understand your needs and to determine whether we are a good fit.


All information is kept confidential and treated with care.

Personal Details
How did you find me?
I saw you on Instagram
I found you on Facebook
Google search
A friend or client referred me
We met at an event
Other
Appointment Preferences

All sessions are delivered online via Telehealth.

Which type of session are you enquiring about?
What days of the week generally work best for you?
What is your preferred time of day for a session?
Therapy Focus and History
Have you previously worked with a psychologist?
Yes
No
Have you received any mental health or neurodevelopmental diagnoses, or are you currently exploring or self-identifying with any?
Yes
No
Are you currently taking any medications?
Yes
No
Any history of substance use or addiction?
Yes
No
Do you currently feel safe and supported in your day-to-day life?
Yes
Mostly
No
Referral and Medicare Fees
Do you have a Mental Health Care Plan (MHCP) from your GP?
Yes
No, but I will get one
No, will be a private client
Do you have private health insurance?
Yes
No

Please note: My fee for standard 50 minute Psychology session is $245, Medicare rebates are available with a valid MHCP.


Private health rebates may apply depending on your fund and level of cover.


For Breathwork Therapy, Assessments and EMDR Intesives fees, check the services pages or enquire directly.

Do you understand and accept the session fees?
Yes
No
Consent
I consent to my information being reviewed and to being contacted regarding appointments.
Yes
I acknowledge that I have provided accurate and complete information to the best of my knowledge.
Yes
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