REQUEST AN APPT WITH ANDREW

How did you hear about Your Calmer Mind? *

Please provide details of Referring GP / Health Professional (if applicable).

Have you worked with a Psychologist, Coach or Counsellor before? *

If you have please share your experience/s of this.

How long ago, how many sessions, what did you like/ dislike about it?

Why are you interested in accessing psychology / consulting with Andrew Grant? *

Why do you think our service might be the right fit for you?

What are you hoping to achieve in working with Andrew? *

What are your goals and expectations in engaging in therapy?

Have you received a mental health diagnosis? *

Yes
No

What is your diagnosis (if applicable)?

(PTSD, CPTSD, Depression, Anxiety etc).

Have you been hospitalised for mental health issues in the past? *

Yes- in the last 12 months
Yes- over 12 months ago
No

Name *

First

Last

Email *

Gender

Age *

Where are you located? *

Please state your suburb. For face to face or video sessions.

Preferred Appointment Day/s *

Monday
Tuesday
Wednesday
Thursday

Time of Day *

Morning
Afternoon
I’m Flexible

Is there anything else you feel is important to include in this expression of interest? *

I understand that by submitting this data I agree to Your Calmer Mind terms and conditions regarding fees, cancellations and, the privacy policy contained on the website. *

I understand

Andrew is conducting ADHD and ASD assessments but not currently not taking on new clients for therapy.