Contact us.info@strengthpsychology.org0424 918 733224 South Valley Rd, Highton, VIC, 3216 Client Name * Date of Birth * Gender: * Person completing form: * First Name Last Name Email * Phone Number * Suburb * How did you hear of us? * School Attending Previous Diagnoses: Does the person being referred have any previous diagnoses? Referral Concerns * Please described the reasons you are seeking psychological support Has the person being referred experienced trauma? Yes - Complex (many events) Yes - Acute (single event) No Unsure or prefer not to say Please indicate support required: Counselling/Intervention Assessment/Testing Both Referral Type * Please indicate support required and how the sessions will be funded: Private Medicare Rebate (Mental Health Care Plan) NDIS Self-Managed NDIS Plan-Managed Cognitive Assessment (IQ Test) ADHD Assessment Vocational/Career Assessment Learning Disorder Assessment Autism Assessment Parent Support Sessions Parent Sessions For children being referred, it is often beneficial to do a small number of sessions with parents only. Is this something you'd be willing to participate in? Yes Maybe/Unsure No Not Applicable Does the referred person have a current care team? If so, who does it include? * Is the person being referred impacted by court orders? Yes - current or recent family court proceedings Yes - relating to an IVO or/and or custody Other Are you open to working with a provisional psychologist? Provisional psychologists are usually in the final stages of completing their Masters degree prior to attaining full registration. Yes Maybe No NDIS Number (If Applicable) Plan Manager (If applicable) What is your preference for session frequency? The majority of our clients attend fortnightly. This information helps us identify clinicians with the soonest availability. Weekly Fortnightly Monthly Anticipated number of sessions: Most people are seen for 6-10 sessions. More complex issues will commonly have longer treatment durations. Intake Session Length For mild issues, a 60 minute intake session is adequate. However, for referrals that have complex issues and lots of important historical information, please book a 90 minute intake. 60 Minutes 90 Minutes What time would you like us to contact you to discuss booking appointments? * Prefer to organise via email Prefer to organise over text 8:30-9:00am 9am-12pm 12pm-1pm 1pm-2pm 2pm-4:30pm 4:30pm - 5pm Thank you!
