New Client Enquiry | amherstpsychology

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NEW CLIENT ENQUIRY

First name

Last name

Email

Phone

Preferred method of communication

Preferred location for appointments (please select all that apply)

Canning Vale

Mount Pleasant

Telehealth (phone or video sessions)

Preferred days for appointments (please select all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Who are you seeking support for?

Child's age

What services are you enquiring about?

Which assessment are you considering? (select more than one if applicable)

Autism

ADHD

Learning / educational

Intellectual disability

Intellectual giftedness

Neuropsychological

Not sure

How will your sessions be funded?

If you are seeking a specific therapy, please mention this below

Other information

Thank you. We've received your enquiry and will be in touch soon.

In the spirit of reconciliation, Amherst Psychology acknowledges the Traditional owners of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and emerging.

We are committed to fostering allyship with the LGBTIQ+ community and creating a supportive and welcoming therapeutic environment. Amherst Psychology is proud to recognise and honour the unique perspectives of all neurotypes. We are committed to creating a space that values the diverse ways in which people experience the world.

© 2024 - Amherst Psychology

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