ADHD Centre
(02) 8788 5785
(02) 8788 5784
SALUTATION : select the optionDrMrMrsMsMasterMiss
FULL NAME :
MOBILE NUMBER :
EMAIL :
DATE OF BIRTH:
WHICH DOCTOR WOULD YOU LIKE TO BOOK? :
select the optionDr. Dorgival CaetanoOther
WHICH PATIENT TYPE ARE YOU? : Please note we are a private clinic and do not offer bulk-billing service. select the optionPrivate patient - MedicarePrivate patient - No MedicareWorkcoverCTPMedico-LegalOthers
MAIN PRESENTING PROBLEM: select the optionAdult ADHDAnxiety DisorderBipolar DisorderChronic painDepressionDrug & AlcoholPTSDIntellectual Disability (Includes ASD)Old Age PsychiatryGeneral Paediatric conditionsDevelopmental Paediatric conditionsWorkcover / CTPMedico-legalOther conditions (please state in the message box below)
HOW DID YOU HEAR ABOUT US? : Please select all that apply
Referral from GPReferral from SpecialistReferral from PsychologistMedia (e.g. TV, Radio etc.)Google searchGoogle mapGoogle adsWord of mouth
UPLOAD YOUR REFERRAL LETTER : A referral letter is compulsory at the time of booking request. This is essential for us to assess the suitability. We only accept PDF (preferred) or JPG.