Personal Details

Name(Required)

First Last Initial

Practice Address(Required)

Street Address City State Post code

Detailed directions on how the clients best get to your practice and parking instructions

Provider Number

Used for health fund queries

Date of Birth(Required)

We use as part of your password access to our member’s section and your calendar

Email(Required)

Used to send your booking confirmations

Enter Email Confirm Email

Mobile Phone(Required)

Mobile number for Clients

If different than your personal number. This is given to clients on their appointment confirmation emails.

Which pricing tier would you like to charge?(Required)

Support Program: $130 standard $150 after-hours

Tier 1: $150 all sessions

Tier 2: $165 standard $180 after-hours

Tier 3: $180 standard $195 after-hours

Tier 4: $195 all sessions

Tier 5: $195 standard $220 after-hours

Tier 6: $220 all sessions

How would you like to pay your membership fees?(Required)

Monthly

Yearly

Therapist Profile

Which of the below are you?(Required)

Clinical Psychologist

Registered Psychologist

Psychotherapist

Counsellor

Sex Therapist

Social Worker

Other

Which health funds are you associated with?

Your provider numbers for each fund

Medicare, Bupa, Medibank Private, Police Health, Teacher’s Health, etc

List of relevant training or courses

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

Do you have any special areas of interest?

E.g. fertility, pregnancy, parenting (young children/teenagers), same sex couples, intimacy, young couples, couples with young families, senior couples, extended families/in-laws, affairs, couples in business, grief and loss/trauma, anxiety, depression, bi-polar, narcissistic personality, borderline personality, Asperger’s, addictions, sexual trauma, etc

Which Therapy types do you offer?(Required)

How many years of counselling experience do you have?(Required)

What are 3 strengths you have as a therapist?

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

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

A shortened version of your professional qualifications(Required)

Please provide them in the abbreviated version

Your profile (biography)(Required)

Aim for 3-4 paragraphs (350 – 500 words) This should be written in third person – such as: Reader friendly rather than academic, and 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

Addictions Counselling:

Sex addiction
Porn addiction

Trauma Counselling:

Sexual trauma
Relationship trauma

General Counselling categories(Required)

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

Which online platforms do you use?(Required)

Therapist Profile Information

Associate Profile Information

Personal Details

Therapist Profile

Counselling Session Types