(07) 5437 7100 Claim Your FREE No-Obligation 15-Minute Consultation So that we can customise your experience and provide you with the best plan to achieve your mental health goals, simply answer the following questions: 1. Which best describes your current situation? (Select all that apply) I’m experiencing anxiety or stress that’s affecting my daily life. I’m feeling depressed or have lost interest in activities I usually enjoy. I’m struggling with a specific trauma or past experience. I have difficulties with sleep or insomnia. I’m facing challenges in my relationships or family life. I’m experiencing grief or loss. I’m dealing with an eating disorder or body image issues. I’m seeking support for a child or adolescent in my care. Other (Please specify): 2. What is the main goal you want to achieve through therapy? (Select all that apply) Reduce symptoms of anxiety or depression. Heal from trauma or past experiences. Improve relationships with family or friends. Develop coping strategies for stress and emotional regulation. Enhance overall well-being and mental health. Other (Please specify): 3. What do you believe is currently preventing you from achieving your desired mental health outcomes? (Select all that apply) Lack of time or availability. Uncertainty about where to start or whom to see. Previous experiences with therapy that didn’t meet my needs. Financial constraints. Fear or anxiety about seeking help. Other (Please specify): 4. Have you seen a mental health professional before? Yes No 5. If yes, what was your experience like? Postitive Neutral Negative Please provide more details if you wish: 6. How long have you been thinking about seeking help for your mental health? Less than 3 months 3-6 months 6-12 months Over a year 7. What is your biggest concern or fear about starting therapy? Not finding the right therapist for my needs. Fear of judgment or stigma. Concern about the cost of therapy. Uncertainty about how therapy works. Fear of confronting difficult emotions. 8. What days are you generally available for therapy sessions? (Select all that apply): Mondays Tuesdays Wednesdays Thursdays Fridays 9. What hours are you generally available for therapy sessions? (Select all that apply): Early morning Mid morning Lunchtime Early afternoon Late afternoon/evening 10. What made you decide to take action and seek therapy now? please specify 11. Why is right now a good time for you to engage in therapy? please specify 12. How committed are you to starting therapy and working towards your mental health goals? (10 being most committed)? 1 2 3 4 5 6 7 8 9 10 First Name * Last Name * Date Of Birth * Email * Mobile * Submit
