Book Appointment We kindly request you to read our Fee and Booking Policy before requesting an appointment. New Patient Appointment Request Form Fill in the form below (* Required) and our reception team will contact you within 2 business days. Salutation*DrMrMrsMsMasterMissFirst Name* First Name Last Name* Last Name Mobile Number*Email* Date of Birth:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What services would you like to book:*Psychiatrist - Dr Charles ChanPsychiatrist - Dr Sukumar RajendranPsychiatrist - Dr Yu-Tang ShenPsychiatrist - Dr Clint PistilliPsychiatrist - Dr Brandon SullivanPsychiatrist - Dr Namrata ShettyAny Psychiatrist with earliest availabilityPaediatrician - Dr Frank ChenClinical Psychology Registrar - Olivia BrownRegistered Psychologist - Elizabeth GrauaugAny Psychologist with earliest availabilityADHD Coach - Ian WahlertNot sure yetWhich patient type are you?*Please note we are a private clinic and do not offer bulk-billing service. We do not accept any workcover / CTP / medico-legal patients unfortunately, please check with your GP for other options.Private patient - MedicarePrivate patient - No MedicareOthersMain presenting problem:*Adult ADHDAnxiety DisorderBipolar DisorderChronic painDepressionDrug & AlcoholPTSDIntellectual Disability (Includes ASD)Old Age PsychiatryGeneral Paediatric conditionsDevelopmental Paediatric conditionsWorkcover / CTPMedico-legalOther conditions (please state in the message box below)How did you hear about us?*Please select all that apply Referral from GP Referral from Specialist Referral from Psychologist Media (e.g. TV, Radio etc.) Google search Google map Google ads Word of mouth Health directories (e.g. healthshare, healthdirect etc.) Other sources Upload your referral letter*A referral letter is compulsory at the time of booking request. This is essential for us to assess the suitability. We only accept PDF (preferred) or JPG. Drop files here or Accepted file types: pdf, jpg. Message (Optional)
