Personal Details

Title

Name(Required)

First Last

Pronouns?(Required)

Practice Address(Required)

Street Address City State Post code

Email(Required)

Used to send your booking confirmations

Enter Email Confirm Email

Personal Mobile Phone(Required)

Mobile number for Clients

To book new clients, we need access to your Practice Calendar. Which calendar do you use?(Required)

How would you like us to access your calendar?(Required)

Your Bank Details(Required)

Please provide your business bank account details, for any associate credits to be paid into each month.

Your birthday (date and month)(Required)

Therapist Profile

Individual standard hours session fee (ISH)(Required)

Must match or be less than your current fee (range $120 - $275)

Individual after hours fee (IAH)(Required)

Must match or be less than your current fee (range $120 - $275)

Couple standard hours fee (CSH)(Required)

Must match or be less than your current fee (range $120 - $275)

Couple after hours fee (CAH)(Required)

Must match or be less than your current fee (range $120 - $275)

Which health funds are you associated with?

Your provider numbers for each fund / Medicare

Please specify which provider numbers can be used for which funds eg. Medicare, ARHG group, Bupa, Medibank Private, etc

List of relevant training, courses and PD(Required)

All other relevant courses/training/workshops you have completed/attended

Which modalities are you trained and specialise in?(Required)

Any other modalities not listed above:

Areas of Interest(Required)

Any areas in which you have expertise and/or specialise in. e.g. fertility, couples with young families, extended families/in-laws, affairs, anxiety, narcissistic personality, borderline personality, adhd, addictions, sexual trauma, etc.

What is the most satisfying and fulfilling part of the work you do?

What is an example of a person or couple you have helped the most?

Please provide detailed directions on how to best get to your practice. Please also include parking instructions, nearby public transport options, and whether the clinic is wheelchair accessible or not. We will send this info to clients at the time of booking.(Required)

A shortened version of your professional qualifications(Required)

" e.g. BA (Hons), GradDipPsych"

Your profile (biography)(Required)

Aim for 3-4 paragraphs (350 – 500 words). This should be written in third person: Reader friendly rather than academic. Most prospective clients would like to hear about your special interest and experience in relationship counselling.

Counselling Session Types

Counselling Types

We are unable to ask too many questions when clients call, so please ensure you’re comfortable with the following topics for those counselling types:

Desire and Intimacy Counselling:

Self-esteem and body image
Reigniting love and passion
Low libido
Differing libidos
Maintaining desire
Arousal issues
Sexual knots

Sex Therapy (Sexual Function and Specific Issues):

Difficulty orgasming
Vaginismus/painful intercourse
Premature ejaculation
Erectile dysfunction
Delayed ejaculation
Transgender issues
Sex and IVF
Sex during and after pregnancy
Gay/lesbian issues and sexuality
Sexual abuse
Fetishes, exhibitionistic disorder
Paedophilia

Trauma Counselling:

Sexual trauma
Relationship trauma

General Counselling Categories(Required)

Session types you're trained in and want to offer to clients

Do you offer online counselling?(Required)

Which online platforms do you use?(Required)

Zoom etc

Profile Photo (this must be an official, professionally-taken photo)

Max. file size: 128 MB.

Please see profile instructions document for photo requirements

Therapist Profile Information

Associate Profile Information

Personal Details

Therapist Profile

Counselling Session Types