Please fill out the following request form to assist us in booking you an initial appointment with our psychiatrist.

We will contact you via SMS to let you know the outcome of your appointment request and will provide further booking details if we are able to assist you.

First Name *

Last Name *

Phone *

Email *

Reason for appointment *

Before you can request an appointment you will need to get a referral from your GP. Please upload your referral to request an appointment.

Referral Upload *

Please Upload Your Referral to request your appointment

I understand that I will be contacted via sms with the outcome of my appointment request.

I understand that my referral will be triaged and there may not be a suitable practitioner to assist me. You will be contacted via SMS if this is the case.

I understand that there are out of pocket costs for all appointments.

I understand that there is a non-refundable deposit of 25% of the initial appointment fee required for the first appointment. ($150 or $200 depending on appointment type)