Patient Forms

Registration and forms

For all appointments during the current COVID-19 pandemic, please see our Welcome packs for important information before attending:

Welcome Packs:
Welcome Pack 2020
Welcome Pack (RSW)

All new clients should return the following forms to Reflection Psychology Group prior to their first appointment:

1. Client Registration Form
2. APS Charter
3. Payment Authorisation

For all digital appointments, the following form must also be returned:

1. Consent for Digihealth Appointment

Note, the nominated guardians of any clients under the age of 18 should return the alternative ‘child client registration’ and consent forms below:

1. Client Registration Form – Child
2. APS Charter
3. Consent for Digihealth Appointments- Child Client
4. Payment Authorisation

Consent and release of information

To nominate family members or loved ones to be an authorised contact for billing and appointment details, please return the following form:

1. Disclosure of Appointment and Billing information

Please note, the content of your appointments remains confidential.

Special forms

Please see the below forms only if indicated by your practitioner or by the reception team. 

1. Consent to release and obtain information

2. Client Registration for Consultation with RSW

3. Client Registration for Consultation with RSW- Child

4. AASW Charter for Consultations with RSW

5. Client Registration Form – Third Party Funded (Work Cover, TAC)

6. Dass 21 Questionnaire

Returning your forms:

Please email your completed and signed forms to reception@reflectionpsychology.com.au.
Alternatively you may wish to post hard-copies of these to the following address:

Reflection Psychology Group
PO Box 770
Camberwell South LPO
Camberwell 3124

If you have questions about these forms please do not hesitate to contact us by phone on (03) 98094888, or fax on (03) 9809 4555.
Thank you.