Book an appointment

Please fill in the form below to book an appointment with The Swinburne Psychology clinic for a consult or treatment.

First name *

Last name *

Contact number *

Postal address *

Postcode *

Email address *

Preferred Pronouns * (this helps us understand the best way to address you)

Date of Birth *

Fee scale * (Consultation fees for individual counselling are set on a sliding scale and calculated at a rate of $1.00 per hour for every $1,000 of family income, with a minimum fee of $20 and a maximum fee of $80 per consultation. An additional $10 administration fee is required for the first consultation)

Reason for appointment *

Where did you hear about the Swinburne Psychology Clinic?

When is the best time for us to call you back between 9:00am and 5:00pm? *

Any comments you wish to make?