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:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Which state are you currently living in?*New South WalesQueenslandVictoriaSouth AustraliaAustralian Capital TerritoryTasmaniaWestern AustraliaNorthern TerritoriesWhat services would you like to book:*Psychiatrist - Dr Charles ChanPsychiatrist - Dr Sukumar RajendranPsychiatrist - Dr Yu-Tang ShenPsychiatrist - Dr Clint PistilliPsychiatrist - Dr Brandon SullivanPsychiatrist - Dr Naveen NatarajPsychiatrist - Dr Pek AngChild & Adolescent Psychiatrist / Adult Psychiatrist - Dr William AckersAny Psychiatrist with earliest availabilityPaediatrician - Dr Frank ChenRegistered Psychologist - Elizabeth GrauaugAny Psychologist with earliest availabilityADHD Coach - Ian WahlertNot sure yetDo you want to book a Face-to-Face appointment or Telehealth appointment?*Some of our clincians only accept Face-to-face patients, some only accept Telehealth patients, some accept both. We appreciate if you could state your preference clearly.Face-to-Face appointmentsTelehealth appointmentsEither is fineWhich 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 DisorderAutism Spectrum DisorderBipolar DisorderChild and Adolescent ADHDChronic painDepressionDrug & AlcoholEating DisorderPTSDIntellectual DisabilityOld Age PsychiatryGeneral Paediatric conditionsDevelopmental Paediatric conditionsOther 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)
