To make an appointment complete the enquiry form below and our friendly support team will be in contact within 48 hours (usually sooner).

If you have any trouble using this form don’t hesitate to call us on (03) 9376 1958 or email us here.

* required

Please tick below to show that you understand the following:

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*
If your current address is not the same as the address you have registered with Medicare, please update your address with Medicare before your first appointment.

Street address


How did you hear about Inner Melbourne Clinical Psychology?*

Date of birth (day/month/year)*

Which location would you prefer? (You can choose more than one)*
KensingtonMelbourne CBDFitzroy NorthTelehealthNo preference

Which days/times would you prefer? (You can choose more than one option)*
Monday 9-4pmMonday 4pm onwardsTuesday 9-4pmTuesday 4pm onwardsWednesday 9-4pmWednesday 4pm onwardsThursday 9-4pmThursday 4pm onwardsFriday 9-4pmFriday 4pm onwardsSaturday 9-3pmNo preference

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.

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 tell us a little about what is bringing you and your partner in. For example, conflict resolution, infidelity, improving communication, parenting or navigating change.*

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.