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New Client Enquiry Form

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Name of client *

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If you are requesting an appointment for your child, please enter their details here.

Date of birth *

Name of parent/guardian

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Phone number *

Email *

Service type (tick all that apply) *

Autism Assessment
ADHD Assessment
Cognitive/Educational Assessment
Therapy
Parenting support
Group
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Referral source *

GP/Paediatrician
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NDIS Support Coordinator
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Funding Information *

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Preferred Location

Heidelberg
Fairfield
Telehealth

Referral type Email

Reason for Referral / Main Concerns *

Please describe the main reasons you are seeking support (e.g. anxiety, behaviour, developmental concerns, family stress, school difficulties, trauma, relationship challenges, etc.):

How soon are you looking to book an appointment? *

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Within 1-3 months
Within 3-6 months
Unsure/flexible

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Is there anything else we should know? *

MINDS OF ALL KINDS PSYCHOLOGY

Neuroaffirming, trauma-informed psychological care in Melbourne and by telehealth across Australia.

PRACTICE

About Minds of All Kinds Psychology

Psychological Assessments

Therapy and Intervention

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Frequently Asked Questions (FAQs)

CoNTACT us

03 7042 9722

info@mindsofallkindspsychology.com.au

64 Mount Street, Heidelberg VIC 3074

148 Station Street, Fairfield VIC 3078

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