Art Therapy Intake Form

Thank you for enquring about art therapy services at Futures In Mind, we look forward to working with you!

If you have any questions, please contact our friendly reception team on 9796 2771 or admin@futuresinmind.com.au

By submitting this form you are acknowledging the following:

Submitting this form does not guarantee that an appointment will be available immediately. Appointments are offered depending on suitability of practitioners. If we believe that we do not have any practitioners with the necessary experience to best support you, we will contact you to let you know.

Our clinic is open Monday to Friday from 8am-5pm. Appointments outside of school hours are the most sought after, and we can not guarantee that appointments outside of school hours will be available.

Futures In Mind is a private clinic and thus all services attract an out of pocket fee. Our fee schedule can be found here. Session fees are payable on the day of the appointment by EFTPOS or cash. Invoices not settled on the day of issue will attract a 10% surcharge. Invoices not settled within 14 days of issue will be referred to a debt collection agency for collection. You are liable for all fees associated with debt collection. 

We understand that sometimes you may be unable to attend an appointment, however due to extensive waiting lists we require a minimum of 24 hours’ notice for cancellations to enable us time to offer the appointment to those waiting. Cancellations within 24 hours' of the appointment will incur a 50% cancellation fee. Cancellations within 3 hours' of the appointment will incur the full session fee.

All communication and information provided is stored securely and only shared with your permission. Futures In Mind complies with state and federal privacy requirements, as per The Privacy Act 1988.


Client Details

Details of parent/guardian completing this form:

Please note that Futures In Mind is not a registered NDIS provider, therefore can only take on NDIS participants who are self managed or plan managed.

Intake Questions

Below are a few questions regarding your main concerns and reasons for seeking art therapy services. Please provide as much detail as possible, as this will help us in assigning the most suitable practitioner.

Current Concerns

History

Risk Assessment

Please note that we are not a crisis service and urgent appointments may not be available. If you have concerns about you or your child's safety, please contact Psychiatric Triage on 1300 369 012.

Court Orders

It is important for your practitioner to be aware of any court orders involving you and/or your child. Whilst we respect your privacy, we require this knowledge to provide a safe environment for you and/or your child and ensure that communication only occurs with those legally allowed to access the information. Futures In Mind has the right to refuse to provide services during active court proceedings. Futures In Mind practitioners are not experienced in court attendance. If you and/or your child's confidential file is subpoenaed by a court we are obliged to provide this. Court reports are charged per hour for preparation.

Other


This will be sent to the contact email provided earlier on this form