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The Lighthouse Psychology Practice

Moorebank: (02) 8798 7082

Campbelltown: (02) 4606 3824

Campbelltown: (02) 4626 5878

Date of Birth: *

Online Appointment Form

Gender: *

Practice Locations

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Full Name: *

Are there days/ times that you prefer for appointments? Are you working and do we need to work around shifts or can you attend anytime? We cannot guarantee that you will be offered the exact times you need, but will do our best. *

Moorebank

Unit 3/43 Heathcote Road

Moorebank NSW 2170

Ph: 8798 7082
Fax: 9600 9582

Are you under the care of a Psychiatrist or Paediatrician? If yes, who do you see? *

Campbelltown

139B Lindesay Street

Campbelltown NSW 2560

(Access via Allman Street)

Ph: 4626 5878
Fax: 4628 3969

Campbelltown

Suite 3/1-9 Iolanthe Street

Campbelltown NSW 2560

Ph: 4606 3824

Fax: 4628 3969

Parking at the end of

King Street, take the

path down to Iolanthe St

Do you prefer to attend the Moorebank or Campbelltown practice? Can you be flexible with location? This way we may be able to get in an appointment sooner. *

Contact Number: *

Psychology

Our Philosophy

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Psychiatry

Email: *

Do you think you would be more comfortable with a male or female Psychologist? Are you open to either depending on who is identified as the most suitable to meet your needs? *

Are there any court or legal proceedings we need to be aware of? Do you have any criminal convictions? Do you require a report for any legal matters? *

to provide evidence-based treatments for a wide range of mental health concerns, that are both affordable and timely

- Veronica Cook

Clinical Director & Psychologist, Assoc. MAPS

Counselling

What do you need support with? Please provide as much information as possible as this helps us to allocate the most appropriate Psychologist for your needs. All information is private and confidential. Please mention if you are coming under NDIS or Work Cover or any other funding.:

Are you currently feeling at risk of harming yourself or anyone else? *

Full address: *