• Enquiry Form - Child

    Child and adolescent (under 16)

  • We look forward to speaking with you soon.  Thank you for giving our intake team the information that will help us help you.  Our current fees can be found here.

  • We understand that it can be quite difficult to get an appointment with a psychologist at the moment.  The Centre for Effective Living has a process in place to provide your child with an appointment that will suit their needs. We regret however that these appointments are quite limited.

    Due to the limited availability of appointments, if your child has experienced distress to the level that they are hurting themselves, thinking about hurting themselves or are in imminent danger to themselves, please exit this form, speak to their treating doctor and/or present at the emergency department of a hospital. 

    The information in this form will be used to determine whether Centre For Effective Living is an appropriate service for your child. The information in this form will be converted to a client file if we are able to provide you with a service. Otherwise, it will be deleted.  Your completion of this form indicates your understanding and agreement to the way we will use this information.

    If you require urgent attention, please contact The Mental Health Line on 1800 011 511 or dial 000. The LifeLine number is 131114.

    Our fees range from $215 to 275 for a Psychologist appointment, and $260 to $330 for a Clinical Psychologist appointment. Click here to view our fee schedule. 

    You may be eligible for a Medicare rebate of $137.05 (Clinical Psychologist) or $93.35 (Psychologist) with a valid referral. 

    Some Private Health Funds cover psychology sessions. Please check with your fund if applicable.

    Please note that we do not offer bulk-billing at our practice. 

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Where did you hear about us?*
  • Where did you hear about us?*

  • Completing the following questions in as much detail as possible will allow us to allocate to the most suitable clinician to support your child's mental health.

  • Has your child received a previous mental health diagnosis?*
  • Referral and Funding Source Details*

  • Our clinicians come from diverse backgrounds and beliefs and are highly skilled in working with clients from different cultural backgrounds. If you have preference for a psychologist who shares a particular language or worldview we will do our best to accomodate this depending on clinician availability. 

    Please select from the questions below if this is applicable to you.

  • Do you require a clinician who speaks any of the following languages:
  • Are you seeking an appointment specifically for a psychometric assessment for your child? E.g. cognitive assessment, assessment of ADHD, Autism etc.*
  • Are you seeking family therapy interventions?*
  • Are you requiring a report for court or custody processes?*
  • Has your child ever found that they see or hear things that other people don't?*
  • In the past 3 months, has your child had an intense fear of gaining weight?*
  • In the past 3 months, has your child been deliberately trying to limit the amount of food they eat to influence their weight or shape?*
  • In the past 3 months, has your child ever used any of the following methods to control their weight: excessive exercise, making themself throw up, laxatives or diuretics, fasting for 8+ waking hours?*
  • In the past 3 months, did your child worry that they have lost control over their eating?*
  • Has your child received frequent detentions at school?*
  • Does your child have a history of suspensions at school?*
  • Does your child show truancy behaviour at school?*
  • Does your child run away from home?*
  • Is your child aggressive towards others? E.g. at home, school, etc.*
  • Do you have concerns regarding your child's alcohol consumption?*
  • Do you have concerns regarding your child's use of cigarettes or vaping?*
  • Do you have concerns regarding your child's exposure to or use of other drugs?*
  • Do you have concerns relating to your child's sexual activity?*
  • If you said YES to any of the behaviours above, is this the main reason you are seeking support for your child?*
  • Has your child received a developmental diagnosis? E.g. Autism, Intellectual Disability, ADHD, etc.*
  • Is this diagnosis the main reason you are seeking support for your child?*

  • You may be eligible for a Medicare rebate with a valid referral. For an overview of our practitioners fees, click here. Please note that we do not offer bulk-billing at our practice.

  • Thank you for completing this form.  Please click 'submit' below, and a member of our intake team will be in touch shortly.  Thank you.

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