New Client Intake Form Please complete the following form and a member of our team will contact you to arrange an appointment Name * First Name Last Name Phone * (###) ### #### Email * Are you filling out this form for yourself or of behalf of someone else? Myself Someone else What concerns are you seeking help with? Are you seeking a specific type of treatment? e.g. CBT, EMDR, ACT Will you be claiming a rebate with Medicare? If so, you will need to obtain a GP referral prior to your session Thank you! A member of our team will respond to you within one busines day. NorthPsych is not a crisis service. If your need urgent assistance, contact Lifeline on 13 11 14 or dial 000.
