Referrals
Welcome to L-Z Psychotherapy!
This is a brief referral form to get in contact with Lachy. This is simply to gain an understanding of the supports you might be needing.
Lachy will endeavor to get in contact within 2 weeks to book in an initial consultation with you.
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Email *
Full name  *
Date of birth *
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DD
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YYYY
Best contact number  *
What has led you to reach out for support?

 *
How long has this been going on for you? *
Have you had previous therapy?

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If yes: Did you find it helpful or not?
Do you take any medications? For mental/physical health concerns? *
Any previous mental or physical health diagnosis? *
Best appointment days? *
What is the best contact for you? What times are appropriate to contact you? *
Are you engaged with other supports, e.g. occupational therapist, psychiatry?

 *
Have you ever been, or still are, involved with police or court matters? *
Other questions?
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