REQUEST AN APPT WITH ANDREW

Andrew does not work with Return to Work SA or 3rd party Insurance providers.

Please complete the form below and we will get back to you within 72 hours. Completing the form does not guarantee an appointment but assists with assessing for best fit for client needs and Andrew’s experience and expertise. Thank you.

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 *

Phone *

Gender

Age *

Where are you located? *

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

Preferred Appointment Day/s *

Monday
Tuesday
Thursday
Friday

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

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