Support starts here Tell us how we can support you and our team will be in touch shortly to discuss the next steps. I am seeking support for I am seeking support for Please select an option MyselfMy childMy partner or family memberMy patientSomeone else Your details Full name (required) Date of birth (required) Email (required) Phone (required) City or suburb Postcode (required) Details Your details Full name (required) Relationship to the child Relationship to the child ParentGuardianFoster carerGrandparentOther family member Other Please provide more information Email (required) Phone (required) City or suburb Postcode (required) Your child's details Child's full name (required) Child's date of birth (required) Details Your details Full name (required) Relationship to the person Relationship to the person PartnerAdult childFamily memberCarer/support person Other Please provide more information Email (required) Phone (required) City or suburb Postcode (required) Person seeking support Person's full name (required) Person's date of birth (required) Support consent* The person seeking support is aware this enquiry is being submitted on their behalf. Details Referrer details Full name (required) Practice/Organisation Relationship to the patient Relationship to the patient GPPaediatricianPsychiatristAllied health professionalSchool or educational professional Other Please provide more information Email (required) Phone (required) City or suburb Postcode (required) Person seeking support Patient's full name (required) Patient's date of birth (required) Support consent* The patient seeking support is aware this enquiry is being submitted on their behalf. Details Your details Full name (required) Relationship to the person Email (required) Phone (required) City or suburb Postcode (required) Person seeking support Person's full name (required) Person's date of birth (required) Support consent* The person seeking support is aware this enquiry is being submitted on their behalf. Support What type of support are you looking for?* Please select one answer ADHD, autism and neurodevelopmentPsychology assessmentOccupational therapy assessmentMental health and anxietyLearning and school challengesParenting supportRelationship supportFamily supportOccupational therapyNot sureMore than one of the above (specify below) Other Please provide more information Please provide more detail about why you are seeking support What would you like support with? (Select all that apply)* ADHD Autism Other neurodevelopmental concern Not sure What type of assessment are you interested in? (Select all that apply)* ADHD Autism Cognitive Learning/academic Developmental Not sure What would you like support assessing? (Select all that apply)* Sensory processing Daily living skills Functional capacity School participation Feeding Not sure What would you like support with? (Select all that apply)* Anxiety Stress and overwhelm Low mood or depression Emotional regulation Self-esteem and confidence Trauma Grief and loss Eating concerns Identity or belonging Other Please provide more information What best describes your concerns? (Select all that apply)* Learning difficulties School refusal Academic performance Attention and concentration Emotional challenges at school Behavioural challenges Not sure What would you like support with? (Select all that apply)* Parenting strategies Behavioural challenges Emotional regulation Family communication Supporting a neurodivergent child Parent-child relationships Family transitions Not sure What would you like support with? (Select all that apply)* Communication Conflict Relationship change Parenting pressures Trust and connection Separation Other Please provide more information What would you like support with? (Select all that apply)* Family communication Family conflict Blended family challenges Separation or transition Parent-child relationships Supporting a neurodivergent family member Not sure What would you like support with? (Select all that apply)* Emotional regulation Sensory processing Daily living skills School participation Social skills Feeding Chronic pain Goal development Not sure Do you have a preferred clinician?Please be aware some clinicians may have longer wait times than others—we will review on submission if wait times are suitable for you. NoYes Preferred clinician Anita BoettgerCarol LucasCasey BarnardElsabé le RouxEmily AbbotJane WotherspoonMichael DuhigPage SchneiderRoger LiewSanto RussoSelina DunnShelley SampsonShiloh Lawrence Availability Please select your preferred appointment times (these are not guaranteed) Morning Afternoon Evening (Wednesday and Thursday only) Saturday As soon as possible I’m flexible Do you prefer in-person or Telehealth appointments? In-personTelehealthNo preference Do you have any accessibility or sensory requirements? Referral pathway How did you hear about Better Life?* Please select an answer GPPaediatricianSchoolExisting clientFamily or friendGoogle searchWebsiteSocial media Other Please provide more details Do you have a referral letter? (Not essential, you can provide this before your first appointment) YesNo Attach referral letter PDF, Word or image file, up to 10 MB. Choose file No file chosen Funding Will you be accessing any of the following? Mental Health Care Plan NDIS Private health insurance Self-funded Not sure Additional information Tell us a little more Are there any court orders, parenting arrangements, or legal considerations we should be aware of?* Please select an option YesNo Consent I understand that submitting this enquiry does not guarantee an appointment and that a member of the team will contact me regarding next steps. I consent to Better Life Centre collecting and storing the information provided in accordance with its Privacy Policy, and to Better Life Centre sharing relevant information with clinicians and staff, to ensure we find the best clinical match. Leave this empty Submit Please enable JavaScript to send this form, or email us directly.
