Complete the booking form below and we’ll be in touch within two business days.
Please tick below to show that you understand the following:
I understand that IMCP does not provide crisis services or immediate appointments (please instead click here), court reports, one-off assessments or services via third parties (please click here)*.
These questions help us to match you up to the right team member. Some are optional, and some are required to make a booking.
Your first name*
Your surname*
Your mobile number*
Your email*
How would you like to be contacted?* Unfortunately if you don't feel comfortable for us to contact you via either phone or email we are not able to assist you. If the reason you don't feel comfortable with us contacting you via either of these methods is due to family violence, we'd recommend you contact 1800 RESPECT on 1800 737 732 for further assistance. Phone callEmailEither, I don't mind
Your current address*
Street address
How did you hear about Inner Melbourne Clinical Psychology?*
Date of birth (day/month/year)*
All of our counsellors are LGBTQIA+ affirmative, but if you would like to work with someone who also has specific training and experience in working with these communities, please tick this box and we'll ensure you're matched with someone who is suitable.Yes, I would like to be matched with a counsellor trained and experienced with LGBTQIA+ communities.
How would you like to see a couples counsellor?* With my partnerBy myself
To book you in, we will need the following details about your partner:
Please be aware that if you do book an appointment with us, we will contact both yourself and your partner with appointment details and information.
Partner's full name*
Partner's date of birth*
Partner's phone number*
Partner's email address*
Partner's current address*
Please tick the issue/s you would like help with (please select at least one issue)* Communication issuesConflict resolutionDeveloping a deeper understanding of yourself and your partnerInfidelity issues or issues around trustNavigating separation or divorceParentingFinancial issuesSupport for coping with external stressors like work, illness, relocating or extended familyUncertainty about the future of your relationshipFalling out of love, growing apart or feeling like you've lost that "spark"Feeling disconnected, resentful, bored or unfulfilled in your relationship
Please let us know if there is any other information that you think it would be helpful for us to know when matching you up with one of our couples counsellors.