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1300 084 200
102580 Santa Monica BLVD Los Angeles
Life Psychologists | Think well, live well.
Think well, live well.
About
Our Psychologists
Bill Ada
Ammata Phathanak
Steve Sutton
Bill Singh
Hugo Rodriguez
Our Approach
Code of Ethics
Fees & Rebates
Services
Assessment
Counselling & Therapy
Anger Management
Pain Management
Panic Disorder Program
Positive Psychotherapy
Social Phobia Program
Couples Therapy
Workplace Health
Employee Assistance Program (EAP)
Career Coaching
Mediation & Conflict Resolution
WorkCover Psychology
Online Therapy
Training
Info
For Clients
For GP’s
Health Professionals
Medicare
Psychological Conditions
Psychology Tools
Useful Links
Blog
FAQ
Contact
Appointment
Referral
About
Our Psychologists
Bill Ada
Ammata Phathanak
Steve Sutton
Bill Singh
Hugo Rodriguez
Our Approach
Code of Ethics
Fees & Rebates
Services
Assessment
Counselling & Therapy
Anger Management
Pain Management
Panic Disorder Program
Positive Psychotherapy
Social Phobia Program
Couples Therapy
Workplace Health
Employee Assistance Program (EAP)
Career Coaching
Mediation & Conflict Resolution
WorkCover Psychology
Online Therapy
Training
Info
For Clients
For GP’s
Health Professionals
Medicare
Psychological Conditions
Psychology Tools
Useful Links
Blog
FAQ
Contact
Appointment
Referral
Online Referral Form
Referral Details
Source of Referral:
Self
GP
Insurer
Employer
Solicitor
Job Services
Services(s) Requested:
Initial Consultation
Independent Psychological Assessment
Diagnostic Assessment
Personality Assessment
Vocational Assessment
Career Assessment
Career Guidance
Employability Assessment
Occupational Psychology Assessment
Fitness for Duty Assessment
Psychological Workplace Assessment
Reporting
Work Safety Assessment
Cognitive Abilities / IQ Assessment
Emotional Intelligence Testing
Skills Testing
Behavioural Profiling
Character Strengths
Mental Health Care Plan
ATAPS (Access to Allied Psychological Services)
Psycho-education
General Counselling / Therapy
Cognitive Behaviour Therapy (CBT)
Acceptance & Commitment Therapy (ACT)
Mindfulness
Interpersonal Therapy (IPT)
Clinical Hypnotherapy
Couples Counselling
Family Counselling
Group Therapy
Mood Assessment Program (MAP)
Positive Psychotherapy Program (PPP)
WorkCover Psychology Services
Comcare Psychology Services
Motor Vehicle Accident (MVA)
Employee Assistance Program (EAP)
Mediation / Conflict Resolution
Mental Health First Aid Training
Motivational Building
Self-esteem / Confidence Building
Communication Skills Training
Career Coaching
Life Coaching
Executive Coaching
360 Degree Appraisal
Leadership Development
Employee Screening
Training Program
OTHER
Other reason(s) for referral:
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Client Details
Please provide details of person being referred.
Name
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Street Address
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Interpreter Required?
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No
Spoken Language(s)
Doctor Details
Doctor's Name
Prefix
First
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Provider No:
Phone
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Practice Name
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Care Plan
A GP Mental Health Care Plan HAS been completed
A GP MHCP has NOT been completed yet
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Appointment Details
Preferred Location
Any
Parramatta
Chester Hill
Fairfield
Merrylands
Workplace Visit
Home Visit
Online / Skype
Preferred Clinician
Any
Bill Ada
Ammata Phathanak
Steve Sutton
Hugo Rodriguez
Bill Singh
Comments / Special Instructions
File Upload:
Accepted file types: pdf, doc, docx, tif, tiff, jpg, jpeg, gif, png, docx, zip.
Consent
By submitting this form I/we hereby give consent to LIFE Psychology & Counselling to arrange an appointment for the above services.
I/we understand that full confidentiality applies to counselling and therapy services.
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