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Brisbane’s Expert Psychology Services for Children, Adolescents & Adults
(07) 3801 1772 (Loganholme) or (07) 3823 2230 (Capalaba)
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Child Psychologist
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Sexual Abuse Counselling
Eating Disorder Counselling
Cognitive Behaviour Therapy
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School Holiday Groups for Children
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Animal Assisted Therapy
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Awareness Weeks
Join Our Team
Home
Services
General
Child Psychologist
Asperger’s Counselling
Autism Counselling
Child and Teenage Counselling
ADHD Assessment and Intervention
Relationship Counselling
Trauma Counselling
Grief Counselling
Anxiety Counselling
Depression Counselling
Sexual Abuse Counselling
Eating Disorder Counselling
Cognitive Behaviour Therapy
Group Programs
2017 Kids Groups
School Holiday Groups for Children
Other
Animal Assisted Therapy
Types of Referrals
Mental Health Care Plans
Better Outcomes in Mental Health / ATAPS
Department of Veterans Affairs
Private
Private Insurance & Employee Assistance Programs (EAP)
WorkCover
Autism Initiative
Better Start for Children with Disability Initiative
Our Team
Psychologist Team
Child & Adolescent Psychologist Team
Client Relationship Team
FAQ
Testimonials
Contact Us
Psychology Blog
Awareness Weeks
Join Our Team
Appointment
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Appointment
Please complete the details below and one of our team members will be in contact to organise your visit with us. Talk with you soon.
Patient Details
First Name
*
Surname
*
Patient Date of Birth
*
Email
*
Preferred Contact Number
*
Reason for attending
Instructions
So we can best match you with one of our clinicians, please tell us a little more about why you are wanting to see one of our clinicians. Please note that the more information we have available will ensure we are able to best fit you with one of our team. Information that will be helpful for us are some of the symptoms you have been experiencing, situations you may struggle with any outcomes you are looking for at the end of your sessions. If you would prefer to speak with one of our team directly regarding this, please indicate this below.
Exisiting or New Client
*
Exisiting Client
New Client
Reason for Visit
*
Are you wanting to book for a formal assessment and report?
*
Yes
No
Appointment Details
Preferred Date
Note: We will ring to confirm if your preferred date and time will be available.
Preferred Time
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02
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HH
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AM
PM
AM/PM
Preferred Practice Location
*
Loganholme
Capalaba
Type of Visit
*
Adult Psychologist
Child Psychologist
Hypnotherapy
Occupational Therapy
Speech Therapy
Animal Assisted Psychotherapy
Referral pathway
*
Is another person or organisation going to be paying for your sessions? If yes please indicate which one below.
I will be paying for my own sessions privately
GP referral
NDIS
WorkCover
Insurance Company
Victims Assist
DVA
Insurance
Other
Are you currently going through court or legal proceedings?
*
Yes
No
Private Health Insurance
Yes
No
How did you hear about us?
*
Referral from Doctor
Referral from Friend
NDIS
Employer
Website
Marketing Flyer
School
Yellow Pages
Social Media ( Facebook etc)
Walk By Location
For Children & Adolescents
Instructions
Please be advised that if you have shared custody with another parent or carer we will require consent from all parties for the child to engage in treatment. We will also require a copy of the court or parenting order for our file.
Parenting order in place
Yes
No
Verification
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