Inquiry Form

PSYCHLAB

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Our Team
Fees and Services
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PsychLab - Inquiry Form

Thank you for contacting us. To help us place you with the right service and clinican, please complete these preliminary details. Please note that this form is not secure, so we only need enough information to contact and assign you, but not to fully identify you.

* Indicates required field

FIRST NAME ONLY *

AGE *

PHONE NUMBER *

WHAT IS THE MAIN ISSUE YOU ARE EXPERIENCING? *

Briefly describe your main concern or reason for making an appointment.

WHAT IS YOUR LEVEL OF DISTRESS (1 = LOW, 10 = HIGH) *

ARE YOU OR OTHERS CURRENTLY AT RISK OF HARM? *

We are not a crisis service. If you require assistance immediately, please dial 000; or contact your GP or Lifeline on 13 11 14.

Additional Concerns: *

Depression Anxiety Stress Grief and loss Alcohol/substance use Relationship issues Work related issues School related issues Performance related issues Health or development related issues Confidence or communication issues

Indicate any additional concerns

Are you accessing services through any of the following? *

Private fee GP or other medical referral NDIS WorkCover EAP DVA Private Health Insurance None of the above

Is your issue related to current or imminent legal matters? *

Have you had at least two doses of a COVID-19 vaccine? *

Yes. No. I have a medical exemption.

Please note that we do not do any medico-legal reports.

Thank you for taking the time to fill in this form. One of our receptionists will be in contact within 2 business days. Please double check that your phone number is correct because we will only try to call you twice.

Submit

Location

Suite 6, The Avenue (58-60 Torquay Road), Pialba

Contact Details

Phone: 0413 676 689
Email: [email protected]

Opening Hours

by appointment
Monday - Friday, 9am - 5pm

Home
Our Team
Fees and Services
Training and Events
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