Request Appointment (OLD) — Berry Collective psychology

Request Appointment

Complete the below booking request form, or if you’d like to find out more, chat to our friendly team on 02 9997 6246 or email us at admin@berrycollective.com.au

Name of Client:

First Name

Last Name

Have you booked a call with our Intake Team? (This is the best way to secure a time that suits you. Please submit this form and then call us on 9997 6246 to book your Intake Call.)

Yes

Alternatively, please select the time period/s below that might be suitable for us to call you.

Mon 9am - 12pm

Tue 9am - 12pm

Wed 9am - 11am

Thur 9am - 10:30am

Fri 9am - 10:30am

D.O.B of Client:

Age of Client:

School Attended (if applicable):

School Grade (if applicable):

Name of person completing this form:

Relationship to Client

Preferred Contact Number:

Other Contact Number:

If you are unable to do one of our standard intake times above, please advise when you are available and we will do our best to accommodate. If you are able to suggest several days/times, that would be helpful.

Email Address

How did you hear about us?

Please select

Please write a sentence or two about why you would like to book an Appointment (e.g. Low mood; Anxiety related to school; Relationship difficulties; Stress) or an Assessment (Cognitive Assessment or Autism Assessment)

Has the Client previously seen a psychologist? If so, what for?

Has the Client previously been diagnosed with a mental health disorder? If so, what?

Who does the Client currently live with?

Does the Client have a referral:

Please select

Yes

If yes, what type?

Please select

If yes, who is the referring GP?

Please click Send to submit this form to Berry Collective Psychology. We will contact you at the time of your booked Intake Call, or we will endeavour to contact you within 2 business days.

If you are experiencing an emergency please call 000 for the Police or Ambulance. For other immediate assistance please see the 24-hour helplines listed on our FAQ page.