Contact Form Contact Form Use this form to enquire about diagnostic assessments, professional training/supervision, group therapy or ask a question before starting individual therapy. If you are ready to start therapy now, the quickest way is to book directly here. Name(Required) First Last Email(Required) Mobile(Required)How did you hear about us?(Required)Please selectClient ReferralWorkshop and/or TrainingGoogle SearchSchoolTreating Clinician ReferralLinkedInBlog PostMore informationPlease provide more information on how you heard about us e.g if a school please provide name of the schoolPurpose(Required)Please selectDiagnostic Assessment (New Client Enquiry)Therapy Services Enquiry (New Client Enquiry)Couples Therapy Enquiry (New Client Enquiry)Professional Consulting, Supervision, Training and Media EnquiriesGroup Therapy: Expression of InterestEmployment EnquiryGeneral Enquiries/FeedbackPlease provide as much information about your enquiry below(Required)Please note that Minds & Hearts does not have the capacity to support acute risk and provide crisis care support. More information on crisis situations can be found hereWhat funding method will you be using at Minds & Hearts? Medicare NDIS Plan Managed NDIS Self Managed Private Health Third Party Paying Privately New ClientHave you/the client or any carers been involved in past, current, or upcoming legal proceedings?(Required)(e.g; court matters, insurance claims/disputes, Centrelink/NDIS disputes, financial/work arrangements, family court proceedings, mandated custody arrangements, DVO, etc.)YesNoThank you for contacting Minds and Hearts, unfortunately we are unable to provide services where court related matters are involved. Professionals experienced with court related matters can be found via services listed on our Referral Assistance page. We sincerely apologise that we are unable to assist you in this instance.Mobile Phone(Required)Date of Birth(Required) DD slash MM slash YYYY What funding method will you be using at Minds & Hearts? Medicare NDIS Plan Managed NDIS Self Managed Private Health Third Party Paying Privately Will you be travelling to the clinic from interstate or internationally?(Required)YesNoPlease provide a description of the current problem(s) that you would like Minds & Hearts to help you with:(Required)Please note that Minds & Hearts does not have the capacity to support acute risk and provide crisis care support. More information on crisis situations can be found herePlease provide information about how the problem(s) above might be impacting day-to-day functioning:(Required)For example: how might the problems impact daily life, emotional functioning, social functioning, school, work, family, or other domains of functioning. Group TherapyGroups(Required)Please select a groupM&H Neurodivergent Burnout Group: Recover & RebuildPEERS Adolescents Group (13-15yo)Momentum: A Neuro-Informed Group for Adults with ADHD and AutismOther/RequestsEligible Particiants would be 21-years or older with a diagnosis of autism and a desire to reduce cycles of burnout. For brand new clients of the clinic a one-hour screening appointment is required to confirm suitability for the group. Group sessions can be covered by Medicare Mental Health Care Plan from your GP or Psychiatrist that specifies Group Therapy - M&H Burnout Group as part of the treatment recommendationsAvailability Monday Tuesday Wednesday Thursday Friday Select AllPlease tick all days available to attend and then the relevant time slots.Monday Availability Morning 10-12pm Afternoon 1-3pm Last Afternoon 4-6pm Tuesday Availability Morning 10-12pm Afternoon 1-3pm Last Afternoon 4-6pm Wednesday Availability Morning 10-12pm Afternoon 1-3pm Last Afternoon 4-6pm Thursday Availability Morning 10-12pm Afternoon 1-3pm Last Afternoon 4-6pm Friday Availability Morning 10-12pm Afternoon 1-3pm Last Afternoon 4-6pm Parent's Name(Required) First Last Child's Name(Required) First Last Child's Date of Birth(Required) MM slash DD slash YYYY Parent Contact Mobile(Required)Parent Contact Email(Required) Diagnosis(Required)Questions or CommentsEmployment EnquiryPosition/Type of Enquiry(Required)Please selectEmployment - Full-TimeEmployment - Part-TimeContractor / CasualUniversity Placement / InternshipSupervision EnquiryOther (Please specify)Other Type of Position/Type of EnquiryProfessional BackgroundAllied Health Discipline(Required)E.G. Psychologist, Speech Therapist, Occupational Therapist, Psychiatrist, etc...Academic Qualifications(Required)Years of Clinical Experience(Required)E.G. 0–2, 3–5, 6+Availability / InterestPreferred Start Date(Required) DD slash MM slash YYYY Availability(Required)E.G. 1–2 days, 3–4 days, full-time, flexibleArea(s) of Interest(Required) Assessment Therapy – Individual Therapy – Couples/Family Therapy – Groups Other (Please specify below) Please select all that applyOther Area of InterestSupporting InformationUpload CV/Resume(Required)Max. file size: 10 MB. Cover Letter / Message(Required)ConsentConsent - Info Recruitment Purposes(Required) I consent to Minds & Hearts storing my details for recruitment purposes(Required)Consent for Future Opportunties I would like to be considered for future opportunities if a suitable position is not currently available. info@mindsandhearts.net 07 3844 9466 Find Us <span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span> Minds & Hearts Shop 2/444 Logan Rd Stones Corner QLD 4120, Australia 07 3844 9466
