New Client Registration Form

Please complete the following form to book an appointment with one of our allied health clinicians.

This form is suitable for all new clients. Once we receive your registration form, our admin staff will be in touch to book in an appointment.

If you need assistance or have any queries please contact us here.

Client First Name*

Client Last Name*

Client Date of Birth*

Day

Month

Year

Client Address*

Client Phone*

Client Email*

Are you booking for yourself or someone else?

Myself

My child/relation

My client

Allied Health Service Requested*

Psychology

Occupational Therapy

Other

Please select payment type*

NDIS Participant Funding

Medicare

Private Health Cover

Private Patient without Rebate

Other

Preferred Location for Appointments*

Clinic in South Perth

Client Home

Client School

Other

*Can select multiple options

Please state preference for a clinician, if any:

Client Presentation*

I understand that Aster Health Group is a private billing practice and that the practice fees (and rebates) will apply as outlined in the Fees section on our website. Please note: We do not currently offer any bulk-billed appointments.*

Yes

Contact Us
Our Team
Fees and Rebates
Privacy Policy

Psychology
Occupational Therapy
Speech Therapy
Physiotherapy
EAP Services

Need Urgent Help?

This website should not be used in emergency situations as it is not monitored at all times. If you need immediate mental health assistance, please contact Lifeline at 13 11 14 for 24/7 Crisis Support or visit https://www.lifeline.org.au/

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