• Appointment Request

    Anxiety House Sunshine Coast

  • Welcome

    Well done in taking the first step in reaching out. This form helps us understand your needs and match you with the most suitable clinician. Your information is kept confidential and securely stored. This is an appointment request - our team will contact you with next steps. Please do not use this form in an emergency. If you are in crisis or immediate risk, please contact emergency services, GP, Lifeline 131 114 or 000.

  • All fields marked with * are required and must be filled.

  • Date of Birth*
     / /
  • Best Contact Method*
  • Have you seen a psychologist before?
  • Are you currently being managed by NDIS?*
  • Preferred days/times*
  • When do appointments generally suit you best?*
  • Appointment preference
  • Legal / Forensic Issues (choose any that apply)?*
  • How did you hear about us?

  • All fields marked with * are required and must be filled.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • I understand that the information provided is confidential and securely stored. I acknowledge that the Anxiety House Sunshine Coast Clinic is a full-fee service and that this form is for non-urgent enquiries. I am aware that submitting this form does not guarantee an appointment and that the clinic will contact me about availability. I agree to be contacted using the details I have provided.*
  • Should be Empty: