New Client Admission – The Lighthouse Psychology Practice

Welcome to The Lighthouse Psychology Practice

If you are a new client, please complete the admission form below. This information goes straight to the Clinical Director who then determines the most appropriate Psychologist for you.

Full Name

Contact Number

Date of Birth

Your email

Gender

Full Address

What do you need support with? Please provide as much information as possible so we can book you with the most appropriate Psychologist. Please mention if you are coming under Work Cover or NDIS. All information is private and confidential.

Are there any court or legal proceedings we need to be aware of? Do you have any criminal convictions? Do you require a report for any legal matters?

Are you under the care of a Psychiatrist or Paediatrician? If yes, who do you see?

Do you currently feel at risk of harming yourself or anyone else?

Are there days/ times you prefer for appointments? Are you working or do we need to work around shifts or can you attend any time? We cannot guarantee we can offer you these exact times but we will do our best.

Are you more comfortable with a male or female Psychologist? Or either?

Which location is preferred? Can you be flexible with either?

Sessions are offered as face to face, phone or video. What is your preference?

Do you have a GP Referral and/or Mental Health Care Plan to upload? It is best to upload a PDF otherwise send your referral to reception@thelighthousepractice.com.au

Are you in private health cover? If yes, which fund and do you have extra's cover?

Please ensure you have a referral letter from your GP if you are wanting to access Medicare rebates. Without the referral letter we cannot process your rebate for you.