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intake@dbtclinics.com
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Name
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Last
Date of Birth
Email
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Phone Number
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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)
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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
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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
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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...)
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