Register Your Interest
YOUR DETAILS
First Name:
*
Surname:
*
Address:
Telephone:
Email:
*
YOUR QUALIFICATIONS AND EXPERIENCE
Are you a qualified:
*
Counsellor
Registered Psychologist
Clinical Psychologist
Clinical Psychologist Registrar
Provisional Psychologist
Do you have a current Australian professional industry membership? If yes, please state your organisation and level of membership.
*
Do you have a current police clearance?
*
Yes
No
Do you have a current Working with Children Check?
*
Yes
No
Do you have a current Senior First Aid Certificate?
Yes
No
Do you have experience working with people who have a disability?
*
Yes
No
Have you completed any disability awareness training?
*
Yes
No
Please select which client types you would like to work with.
*
Individuals
Couples
Families
Children (under 13 years)
Adolescents (13-18 years)
Please select which areas you have experience working in and are willing to work in.
*
Addictions
Anger Management
Anxiety
CBT
Depression
Domestic Violence
Employee Assistance Programs
Eating Disorder
Family Therapy
Grief and Loss
Group Work
Hypnotherapy
Parenting
Personal Issues
Pre & Post Natal Issues
Sex Therapy
Sexual Abuse
Trauma
YOUR AVAILABILITY
Preferred days:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred hours:
*
Mornings
Afternoons
After Hours
Weekends
Do you currently have your own private practice?
*
Yes
No
If you have your own private practice and are able to accept referrals, please state the location/s of your practice.
If you have your own private practice, do you have accessible facilities to receive clients with a disability?
If you are thinking of starting your own private practice, would you like to find out about our business incubation program for new counsellors?
*
Yes
No
Other relevant information
Submit
Should be Empty: