Add Profile – GPbook Psychology Edition

Please enter the "Linking Code" provided to you. e.g. A123:

Title (required)

Last Name (required)

First Name (required)

Gender (required)
MaleFemaleOther

Your Qualifications (required)

AHPRA Number (required)

Your Email (required)

Your Email Preference (required)

Your Mobile

Your Mobile Preference

Phone Number

Fax Number

Primary Clinic Details. If this is the same as the clinic provided with the initial listing please write 'same' into Clinic Name below.

Clinic Name

Address Line 1

Address Line 2

Suburb

Postcode

Clinic Phone Number

Clinic Fax Number

Clinic Email

Clinic Website

Secondary Clinic Name

Address Line 1 (Clinic 2)

Address Line 2 (Clinic 2)

Suburb (Clinic 2)

Postcode (Clinic 2)

Clinic Phone Number (Clinic 2)

Clinic Fax Number (Clinic 2)

Clinic Email (Clinic 2)

Clinic Website (Clinic 2)

Special Interests (select a maximum of 10 in total; hold down 'Control' on your keyboard to select more than one)

My interest wasn't listed. Make a suggestion.

Introduce yourself. Maximum 200 words.

Age Groups (select the age groups you see - select as many as apply).
Children 12 and under.Teenagers 13-17.Adults 18 years and over.

Other age group (please specify).

Exclusions. Are there any types of problems you don't see?

Billing Policy.

Standard Consultation Fee (50 minutes).

Billing Policy

Billing Policy Comments.

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