NEW CLIENTS: First Appointment Request
*
indicates required
Name:
Email:
Comment:
First Name
*
Last Name
*
Email Address
*
Phone Number
Date of Birth
Accepting adult clients (18+).
Gender
Male
Female
Other
Appointment Type
*
Private Client (no referral)
Medicare (doctor referral + Mental Health Care Plan required)
Presenting Issue
A brief description of your main problem (100 words or less).
Affordability
*
Reduced Fee [2026]: $90 gap payment with Medicare referral
Regular Fee: $280
Do you prefer a morning or afternoon appointment?
Any time
Morning
Afternoon
Preference
Office Consultation
Video Call
Phone Call
