Counselling Assistance Application Form

COUNSELLING SUBSIDY APPLICATION FORM
CFT provides financial assistance to members to undergo counselling with a registered Psychologist or Psychiatrist. These can be in-person or telehealth appointments.

Process:

Person requesting service must hold a current CFT Membership.

1. Complete this online form;

2. Attach any invoices for reimbursement;

3. You only need to fill in this form the first time you claim. In future just email your invoices to general@cftas.org.au.

4. CFT will endeavour to process your application within 7-10 days (subject to staff availability).
Under the Federal Government's Better Access to Mental Health program you are entitled to Medicare rebates for up to 10 sessions per calendar year with a registered psychologist. CFT will fund the gap between this rebate and the fee charged by your provider. The gap can be up to $100, but this will vary depending on what your counsellor charges. To receive the Medicare rebate you need to get your GP to write a referral and a Mental Health Care Plan. CFT will only fund the full cost of counselling sessions if you have used all the available sessions under your mental health care plan and require further sessions. If you do not get a Mental Health Care Plan, dependent on what your psychologist charges, our support will only fund around 4 visits. In the case of a psychiatrist appointment, please complete the form and our team will be in touch with further information. Do you understand this? *
Name of member undergoing counselling*

First NameLast Name
DOB of CF Patient

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState

Post Code
Email*

Confirmation Emailexample@example.com
Mobile Number
Details of person completing this form (if different from above)

Name

Street Address Line 2

Relationship

Mobile Number
Relationship to person with CF
Counselling Details
Name of psychologist you will be seeing*
To access this subsidy you need to pay for your appointment, and then provide a copy of your receipt showing the fee and the Medicare rebate. CFT will then reimburse the gap fee to the bank account listed below.
BSB*
Account Number*
Bank account holder*
Name
Please provide a receipt/invoice from the practice that outlines the total fee, Medicare rebate received and gap fee.

Browse Files

Cancelof
DECLARATION

I declare that all information I have provided to Cystic Fibrosis Tasmania is true and accurate. I understand if it is found that I have knowingly provided false or inaccurate information I may no longer be eligible to be a member, or receive any or all of the services and benefits provided by Cystic Fibrosis Tasmania.
E-Signature Name*
Date*

DayMonthYear
Date
Should be Empty:

COUNSELLING SUBSIDY APPLICATION FORM

Counselling Details