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*DrMrMrsMsMasterMissName* First Last Mobile Number*Email* Date of Birth:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What services would you like to book:*Psychiatrist - Dr Charles ChanPsychiatrist - Dr Sukumar RajendranPsychiatrist - Dr Yu-Tang ShenPsychiatrist - Dr Clint PistilliPsychiatrist - Dr Namrata ShettyPaediatrician - Dr Frank ChenPain Specialist - Dr Yi-Ching LeeClinical Psychologist & Educational and Developmental Psychologist - Keith KongPsychologist - Dr Natalia YeeClinical Psychology Registrar - Olivia BrownADHD Coach - Ian WahlertPhysiotherapist - Adrian BrezniakNot sure yetWhich patient type are you?*Please note we are a private clinic and do not offer bulk-billing service.Private patient - MedicarePrivate patient - No MedicareWorkcoverCTPMedico-LegalOthersMain presenting problem:*ADHDAnxiety DisorderBipolar DisorderChronic painDepressionDrug & AlcoholPTSDGeneral 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 Message (Optional)
