New Client Intake
We would like to find out a bit more about your current situation with the purpose of ensuring our specialised perinatal practice will be the best fit for you. This information will be stored securely. Please check your email after submitting this form for the next steps from here.
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Email *
Given Name/s *
Last Name *
Mobile Phone Number *
What is your Date of Birth? *
MM
/
DD
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YYYY
Which State do you live in? *
What type of appointments are you interested in? *
Which councils would you be prepared to attend physical face-to-face appointments in?
 *
Required
Are you interested in attending a after-hours sessions (5pm - 9pm) or Weekends which attract an after-hours fee of $75?  

These spots are available immediately reducing your wait time.

Please note there we don't offer bulk-billed after-hours or weekend appointments and your ongoing appointments will remain after hours. You will not return to a bulk-billed spot.
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What time of day can you attend appointments?
9am - 1pm (Mornings)
1pm - 5pm (Afternoons)
5pm+ (Afterhours)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you interested in before-hours appointments at 7am. These are currently bulk-billed?
 *
Are you willing to work with a male therapist? *
Have you already attended therapy sessions with another clinician using your Mental Healthcare Plan in 2024?

(You can only access 10 Medicare sessions in a calendar year.) *
How many Mental Health Care Plan sessions under Medicare have you used in 2024? If none, please type 0. *
What phase of the perinatal period are currently in? *
Required
How many weeks pregnant are you or your partner currently (if applicable)?
How old is your child/ren (if applicable)?
What is your current relationship status? *
Who do you currently live with? *
Do you have at least one person who supports you emotionally? *
Who supports you emotionally? *
Have you seen a mental health professional previously? *
If yes, when did you last see someone and was it helpful?
In the past, have you experienced the following? Tick all that apply.
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Required
Please rate your mental health within the last week from 1 (feeling suicidal) to 5 (feeling the best you could feel)
 *
What are the main reasons you are coming to therapy now? (tick all that apply)
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Required
Which of these have you experienced in the past week? (tick all that apply)
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Required
Do you currently take medication for mental health?
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If yes, what is the medication and what is the dose?
Do you currently use elicit drugs or consume alcohol excessively?
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Who referred you or suggested you attend Mums Matter Psychology?
 *
Required
Are you currently working with any other services?
 *
Required
Is there anything else you'd like us to know?
A copy of your responses will be emailed to the address you provided.
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