Appointment Request

Please note we currently have a wait time of approximately 4 weeks for both our Forest Lodge and Pymble centres.

You can join the waiting list by filling out an appointment request form below.

Please enable JavaScript in your browser to complete this form.

First Name

(of the client)

Last Name

(of the client)

Age

Please note we do not see children under the age of 14 at Birchtree

Preferred Pronouns

Phone Number

Email Address

Please do NOT use a yahoo email address as they are not supported by our system.

Who is your GP?

Your postcode

Who referred you to Birchtree Centre?

Have you had therapy before?

Do you have a history of:

Please select all that apply

Areas of concern: please say a little about what you would like help with

This information ensures we match you with a clinician who has the best expertise and experience to meet your needs

List all possible days / times of day you could be available for ongoing appointments:

Have you been referred to a specific clinician? If yes please fill in the name of the clinician.

Preferred Birchtree Centre

Pymble
Forest Lodge

Please note we do not offer ongoing Telehealth sessions

Do you have a Mental Health Care Plan (MHCP)?

Yes
No
In the process of obtaining one

*WE DO NOT BULK BILL but we accept MHCPs.

Is there any other important information you feel we should know or bear in mind?

If you filled this in on behalf of the client, please clearly state your name, relationship to the client, whose contact details you have included above, and confirm that you have consent to add the client to our waiting list.

Would you like to sign up to our client newsletter where you'll get the latest information on new groups and workshops at Birchtree?

Do you give us permission to contact you in the future regarding research?

Birchtree Centre is a research partner with Sydney University and the Matilda Centre, time to time we conduct research studies aimed at how to better serve our community.

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