Register your contact details here, and our intake officer will contact you. * I am registering interest for myself (Client) I am a health professional referring a patient / client Client Name * First Name Last Name Client Phone * Client Email Do you have a Mental Health Treatment Plan from your GP? Yes No If you are a health professional: Your Organisation Name First Name Last Name Phone (###) ### #### Email Thank you for submitting your interest in our Cardiac Counselling Clinic! In the meantime, please see your GP to obtain a Mental Health Treatment Plan to access counselling. This can be faxed to 0394459296. Our admin will contact you as soon as possible. Thank you!
