Book Now - Clinical Psychologist | Aster Health Group, East Victoria Park

new client form

Please complete the following form to book an appointment with one of our clinical psychologists.

If you need assistance, have any queries, or would prefer to speak with us over the phone, please use out contact details below.

Client First Name

Client Last Name

Client Birthday

Day

Month

Year

Client Address

Contact Phone

Contact Email

Contact Name & Relation (if not client)

Preferred Availability

Please state preference for one of our clinical psychologists, if any

Reason for Appointment

Referred by:

Referrer Contact Details:

Please select payment type

Medicare Rebate through Mental Health Care Plan

Private Health Insurance

Private Payment without Rebate

NDIS Participant Funding

If you are seeking services as an NDIS participant, are you either:

Plan-managed

Self-Managed

*Please note we cannot currently service NDIA managed participants

Plan Manager details, if applicable

NDIS number, if applicable

Amount of NDIS funding/sessions available, if applicable

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

874 Albany Highway

East Victoria Park, WA 6101

0461 431 456

admin@asterhealthgroup.com

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