Complete this form to request an appointment with one of our Therapists. A member of our friendly team will be in contact. Your contact details First Name Last Name D.O.B Email Phone Are you an existing client? Yes No Do you have private health insurance? Yes No Do you have a mental health plan from your GP? Yes No Please attach a copy of your Mental Health Care Plan Your appointment Which psychological service are you interested in? Individual Therapy Session Educational Assessment / Testing Other Location Joondalup Ellenbrook Jandakot Cockburn Central Preferred appointment time AM PM Do you have a preferred Therapist? Any Available Karen Huggett Renn Cheah Nikolas Milosevic Asha Natalwala Joseph Fleming Samuel Nicholson Emilee Salleo Roger Harris Sharleen Delane Min Choi Danelle Priddy Claire Culley Bronwyn Tindal Submit