Intake form - adult

This form should be completed by the individual who attends the appointment and cannot be completed on behalf of another individual. If you are under 18 years old, please ask a parent or guardian to complete the intake form for children on your behalf.

After this form has been submitted, a senior practitioner will contact the person named in this form by phone to ensure they are assigned to the best practitioner for their circumstances, and to confirm a suitable day and time for the first appointment.

For individuals under the age of 18, a parent or legal guardian must complete the intake form for minors, which can be found at the following link: 

https://wisepsychologyptyltd.snapforms.com.au/form/wp--intake-form---child

If you are under the age of 18, please discontinue completing this form. 

If there is an issue with contacting a parent or legal guardian to complete the intake form for minors, please email hello@wise-psychology.com to provide details, and the matter will be reviewed by a senior practitioner.

By providing these details, you consent, when possible, for Wise Psychology as a courtesy to submit claims on your behalf in the full knowledge that should a claim for a third party not be accepted that the client receiving the service is liable for the associated costs and not the third party.

By providing these details, you consent to the named individual being contacted in the event of emergency, or when contact is deemed clinically necessary by your practitioner and you are unable to be contacted directly. 

You acknowledge contact with this individual may result in disclosure of the existence of the treatment relationship.

After submitting this form, a practitioner will phone you to introduce themselves and schedule your first session. Please select as many of the following options as possible for them to contact you.