Emergency Numbers - Western Plains Psychology & Counselling

Name of Client(Required)

First Last

Date of Birth of Client(Required)

Phone(Required)

Email(Required)

Summary of what is going on/presenting issues so we can determine who is best suited for you.(Required)

Funding

GP Referral (Mental Health Care Plan)

Private Health Insurance

NDIS – please note we are only able to see self-managed clients

Workcover

Other

Preferred Appointment Days/Times

E.g., Weekdays, afterschool, during school hours. We cannot guarantee preferred days and times will have availability.

Mode of Appointments(Required)

In Person

Telehealth (Phone Consults / Zoom)

No Preference / Open to Both

Wanting to book with:

Psychologist

Provisional Psychologist: a clinician who has or is nearing completion of their tertiary qualifications and is eligible to undertake a program of supervision.

Counsellor: work with clients experiencing a wide range of psychological difficulties. Use similar methodologies to assist with coping and dealing with stressors.

Social Worker: a person whose job is to help people in a particular area who have social disadvantages or personal problems.

No Preference

Name

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