Request an appointment


Complete the new patient request form online.

This form allows us to review your situation to ensure we best serve your needs.

* Once we receive the form it will take 2-3 days to call you back.  If you are not available, we will leave a message. If after 7 days you have not been back in contact with us , we will assume you no longer wish to proceed and will destroy the form.

    Patient's full name
    Patient's Date of birth (day/month/year)

    Your E-Mail

    Name of school & class year (if applicable)
    Name of parent (s)/ guardian (s)

    Which Dr you wish to see
    Please select clinician for me

    Please provide a short summary of your situation /background

    Please indicate what you require help with:

    Is there an acute risk of suicide or harm to others what we need to be aware of?

    List previous mental health admissions and dates. If applicable.

    Please provide name of any previous professional involvements.
    Have you previously undertaken any neuro psychiatric assessments? If so are you able to supply a copy?

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