Make an appointment

To make an appointment complete the enquiry form below and our friendly support team will be in contact within three business days (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*

As part of the booking process, we will get in touch with you via phone, email and/or SMS. If you’d prefer for us to not contact you via any of these methods, please indicate this below
Please do not call mePlease do not SMS mePlease do not email me

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

Suburb
Postcode

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 NorthNo 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

Is there a particular psychologist you would like to see?
Our Support Team will endeavour to match you with your preferred psychologist if their availability allows

 
Please tick the issue/s you would like help with (please select at least one issue)*

AnxietyDepressionStress and burnoutRelationship difficultiesChildren’s mental healthGeneralised anxietySocial anxietyPanic attacksPhobiasHealth anxietyTrauma and post-traumatic stressEating disordersBody image issuesPre and postnatal mental healthGrief and lossLow self-esteemPerfectionismAutism spectrum disordersBody dysmorphic disorderAdjusting to a new country and culturePeople from immigrant, asylum seeking and refugee backgroundsSupport for abusive relationshipsSexual assaultJob or study dissatisfaction
Carer supportAdjustment to stressful life changesDrug and alcohol issuesEmotional difficultiesBipolarSleep problemsAnger managementCommunication skillsIdentity issuesPsychosisObsessions and compulsionsChronic illness and painLiving with cancerLearning difficultiesCouples counsellingSexuality and sexual developmentWellbeing and self-careSelf-developmentInternet and game addictionFamily issuesParenting issuesSchool-based issuesTerminal illness and end of life issuesWomen's health issuesDissociation

Of the issues above which one feels like the main issue, or the one you feel most concerned about?

When people mention drug and alcohol issues we ask a few extra questions. This information is really helpful in assisting us to figure out whether our clinic is the best place for you to get support.

If you have trouble answering these further questions, please just write "I don't know" and we'll be in touch with you to try to figure it out together.

Which substance(s) you are wanting assistance with?*

How often are you currently using this substance(s) per week?*

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*

When clients mention an eating disorder we like to get a bit more information, such as, which eating disorder you are referring to and whether you are linked in with any other services such as a GP. It also helps us to know if this is the main reason bringing you in, or if there is something else that feels more pressing or concerning.

Please provide more information that will ensure that we are able to provide more specific recommendations for support.*

When clients mention anger management we like to ask a few extra questions to help us to figure out whether our clinic is the best place for you to get support.

If you have trouble answering these further questions, please just write "I don't know" and we'll be in touch with you to try to figure it out together.

Can you let us know more about the specific issues you are having with your anger?*

Has your anger ever resulted in you being violent? Please provide more information if so.*

Please provide some more information about your concerns around obsessions and compulsions. If you have trouble answering this question, please just write "I don't know" and we'll be in touch with you to try to figure it out together.

Have you been diagnosed with psychosis by a GP, psychiatrist or other mental health professional?*
YesNo

If you have trouble answering these further questions, please just write "I don't know" and we'll be in touch with you to try to figure it out together.

Please provide us with some information about who made this diagnosis and when this occurred?*

If you are currently seeing a psychiatrist, please provide their name and phone number.*

If you are currently taking medication, please let us know which type of medication and what dose you are taking.*

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 psychologists.

Do you have a Medicare referral/GP letter/Mental Health Treatment Plan?
YesNoUnsure

If yes, what is the name of your GP and/or your GP clinic?

What is the date of your referral or letter?

If you have already used sessions with another psychologist, how many have you used since 1st January this year?
If you are unsure about this you would need to speak with Medicare (Ph: 132 011) and bring this information along to your first session.

As an existing client, you can book your appointments online.

You can also book an appointment by filling out the form below.

* required

Please tick below to show that you understand the following: