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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.
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Indicates required field
FIRST NAME ONLY
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AGE
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PHONE NUMBER
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WHAT IS THE MAIN ISSUE YOU ARE EXPERIENCING?
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Briefly describe your main concern or reason for making an appointment.
WHAT IS YOUR LEVEL OF DISTRESS (1 = LOW, 10 = HIGH)
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ARE YOU OR OTHERS CURRENTLY AT RISK OF HARM?
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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:
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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?
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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?
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Have you had at least two doses of a COVID-19 vaccine?
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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.
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Home
Training and Events
Clinic and Supervision
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