Schedule Your Appointment

Take the first step toward healing and connection. Complete the form below and we'll be in touch within 24 hours to confirm your appointment.

New Client Appointment Form

We're here to support you on your journey toward healing and growth.

Please complete this form with as much detail as you're comfortable sharing. This information helps us match you with the right therapist and prepare for your first session.

All information is kept strictly confidential in accordance with HPCSA ethical guidelines and privacy standards.

What happens next?

We'll review your request within 24 hours
A team member will contact you to confirm details
Your first appointment will be scheduled

Personal Information

Full Name *

Email Address *

Phone Number *

Address (City/Suburb)

Appointment Preferences

Preferred Session Format *

Preferred Days & Times *

Therapist Preference

Preferred Contact Method *

Additional Information

How did you hear about us?

What brings you to therapy? (Optional)

This information is confidential and helps us provide better support.

Consent & Agreement

I consent to receiving counselling services and understand that I can withdraw this consent at any time. I understand that counselling is a collaborative process and requires active participation.

I understand that all information shared during sessions is confidential and protected under HPCSA ethical guidelines, except where disclosure is required by law.

I agree to the cancellation policy requiring 24 hours notice for cancellations or rescheduling. I understand that late cancellations may incur fees.

I'm not a robot (reCAPTCHA verification)

Protected by reCAPTCHA Privacy Policy and Terms of Service apply

By submitting this form, you agree to be contacted by our team to confirm your appointment details.

Prefer to Contact Us Directly?

You're welcome to call or email us directly to schedule your appointment.

Call: 060 447 3273 Email Us