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First Name

Last Name

What session types will are suitable? *

In-Person

Telehealth / Video

Telephone

Important Information *

Next Chapter Health is not a crisis service. If you require urgent support please contact Lifeline on 13 11 14 and call 000 for all emergencies. By submitting this form you confirm that your need is not urgent and there is not a current risk to your safety. Completing this form doesn't guarantee Next Chapter can offer you an appointment but we can contact you if one becomes available. If you do not hear from us, no suitable appointments have become available. By completing this form, you authorise us to contact you using the details above and confirm you are aware of our current fees, available at www.nextchapter.health/fees.

Yes, I confirm that I understand and agree to the above points