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Please complete an intake form below if you are a new client wanting to book in with Bianca. ​

For more information about rebates and appointment times, please visit the FAQs tab. 

Child/Adolescent Intake Form

Please complete this form if you are enquiring about therapy for your child. If you are an adult enquiring about therapy for yourself, please scroll down to the Adult Intake Form.

Do all required parental/guardian parties consent to the child attending sessions? (If a custody agreement is in place, consent from both parents is required for sessions to proceed.)
Yes
No
Do you have, or plan to access, any funding or rebates for sessions?
Medicare rebate (GP Mental Health Care Plan)
NDIS (self-managed)
Private health insurance

Adult Intake Form

Date of Birth
Day
Month
Year
Do you have, or plan to access, any funding or rebates for sessions?
Medicare rebate (GP Mental Health Care Plan)
NDIS (self-managed only)
Private health insurance

We acknowledge the Traditional Custodians of Country throughout Australia and their continuing connection to land, waters and community. We pay our respects to Elders past, present, and emerging, and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

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