07 5646 3811
intake@dbtclinics.com
MELB - SYD - GC - BRIS - ONLINE

Australian DBT Institute Certified Programs

Australian DBT Institute Certified Programs

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Contact DBT CLINICS

Call us on 07 5646 3811

Head Office: Level 1, 115 Scarborough St Southport QLD

Admin: admin@dbtclinics.com - Intake: intake@dbtclinics.com

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Name *

First

Last

Date of Birth

Email *

Phone Number *

Address

GPs Details &/or Psychiatrist Information

Your Current Therapist's Details

If you currently have a Psychologist, Social Worker or Counsellor please provide their details. If you do not have a therapist please type "No current therapist"

Please indicate your requested service(s) *

DBT Individual Therapy
RO-DBT Individual Therapy
DBT Adult Group (Online DBT)
RO-DBT Skils Class (Online DBT)
DBT Adult Group (Gold Coast DBT)
RO-DBT Skils Class (Melbourne DBT)
DBT Adult Group (Melbourne DBT)
RO-DBT Skils Class (Gold Coast DBT)
DBT Adult Group (Sydney DBT)
DBT Graduate Group (Online)
DBT Adult Group (Brisbane DBT)
DBT Carers Group (Online)
DBT Youth Group (Online DBT)
Clinical Assessment
DBT Youth Group (Gold Coast DBT)
General Counselling

Please indicate your preferred day of the week for a DBT Group/Skills Class

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Any Day of the Week

Please indicate your preferences for Individual Therapy (if you are seeking individual therapy)

Monday appointments
8am-10am appointments
Tuesday appointments
11am-1pm appointments
Wednesday appointments
2pm-4pm appointments
Thursday appointments
5pm-7pm appointments
Friday appointments
8pm-10pm Appointments
Saturday appointments
Any Time of the Day
Any Day of the Week

Choose your preferred days and times for appointments above.

Referral Information (Mental Health Plans, Referral Letters, Crisis Management Plans, Assessments...)

Click or drag files to this area to upload. You can upload up to 5 files.

If you have any referral information it is always useful to provide this information to support our intake processes.

Further information or Messages

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