Appointments

What is the name of the client looking to book in?*

Is a Parent/Guardian filling out this form?*

Yes

If yes, what is the name of the Parent/Guardian?

Phone Number*

Email Address*

Date of Birth*

Please select from the options below the appointments you are after:*

Therapy

Assessment

Groups

Other

If you selected 'Other' above please explain:

Please choose your preferred appointment type below:*

Phone Consult

In-Person

Telehealth (Online)

We have a Registered Psychologist and 2 Provisional Psychologists. Would you be okay seeing a Provisional Psychologist? The only difference is the Registered Psychologist has completed an extra year for Medicare Registration, they are all fully qualified.

Yes

Maybe. I need more information.

Choose your benefits below:*

Medicare

NDIS

Private Health

None of the above

Describe your concerns*

We operate Mondays to Wednesdays 9am to 5pm. Which day/s would suit you best?*

Monday

Tuesday

Wednesday

Thursday (Waitlist)

Friday (Waitlist)

Which time/s would suit you best? Each therapy appointment goes for 50 minutes.*

9 - 9:50 am

10 - 10:50 am

11 - 11:50 am

12 - 12:50 pm

1 - 1:50 pm

2 - 2:50 pm

3 - 3:50 pm

4 - 4:50 pm

Want to schedule an appointment? Fill out the form below to begin!

Southern Psychologists

15 Penney's Hill Road Hackham, SA 5163

0409 447 912

admin@southernpsychologists.net.au

“We show our respect and acknowledge the traditional custodians of this land, of elders past and present, on which this event takes place.”