headspace Ballarat - Single Session Support Logo
  • Single Session Support

    headspace Ballarat offers Single Session Appointments for non-crisis, confidential counselling which is usually available within 24-48 hours of enquiry.  Please contact headspace Ballarat on 5304 4777 if you have any questions about how to complete the following application form.
  • Is this the right option for me?

    headspace is not a crisis service or an acute mental health service therefore headspace is NOT appropriate if:

    • You are in crisis:
    If you are experiencing a mental health crisis and immediate help is required.

    • You are experiencing severe mental health symptoms:
    If you are dealing with severe mental health symptoms, such as acute thoughts of suicide or self-harm, it is crucial to seek immediate help.

    • It is a Medical emergency.

    • You are in immediate risk or harm.

    For medical or mental health emergencies, contacting emergency services or going to the nearest emergency room is recommended.

    Alternatively, Access and Triage at Grampians Health can be contacted on 1300 247 647 24 hours a day, 7 days a week.

    Emergency Services - call 000.

     

    Other crisis support numbers if you want to talk to someone urgently:

    Lifeline 13 11 14

    Kids Helpline 1800 551 800

    Suicide Call Back Service 1300 659 467

  • One headspace

    Non urgent support can also be accessed by creating a headspace account at https://headspace.org.au/register/

    You can speak to someone 1-on-1 via online chat, email or over the phone through eheadspace. Visit online via eheadspace or call 1800 650 890.

    headspace Ballarat also provides youth work appointments for up to 6 sessions and self-referrals can be completed online to access this support option.

  • Single Session Support Application Form

  • Young Person details:

  •  - -
  • Client Consent

  • Contacts

  • Emergency Contact

    We only contact this person if we have concerns for your safety and wellbeing. This person must be 18 years or older.
  • Other information

  • Young person signature: Please note that by the notation of my name in the following section, this is an electronic representation of my signature for all the purposes required in this document, just the same as my normal pen and paper signature

  • Clear
  • Pre-Session Client Questionnaire

    Welcome. To assist us in maximising the effectiveness of your consultation, please complete the following questionnaire.
  • What are the main issues that bring you to this service?

  • Should be Empty: