Request an Appointment Is this appointment for you? Yes No Referrer's Name Referrer's Number Relationship to client Referral made with client’s consent Yes No Is the client under the age of 18? Yes No Please complete the below form with the details of the person you are referring.Support type:(Required) Assessment Individual Therapy (Waitlist open) Supervision (Group/Individual) EAP Support (Covered by your workplace) Therapy Groups – Expression of Interest Support through National Office for Child Safety Public Consultation Project Group Type Social Anxiety for people with ID Friends and family of people who have committed serious criminal offences Friends and family of people who have committed crimes against children (material or physical) National Office for Child Safety Public Consultation Project (NOCSPCP)(Required)Meliora Psychology is the provider of psychological support for people who require it as a result of participating in the consultations associated with the National Office for Child Safety Public Consultation Project. Through Meliora Psychology, project participants have access to two psychologists who bring extensive experience in providing trauma informed counselling/psychological support, and work with people who have experienced child sexual abuse. If you have participated in the consultations and feel that you need to speak to someone, you can request an appointment with Meliora here within one week of participating in an interview or focus group. Please fill in the details requested in this form and we will get back to you within 2 business days to schedule an appointment. It is important to note that the cost of the session will be covered by the project. Each person is entitled to one consultation with Meliora and no ongoing support is available through this project. I confirm that I participated in the NOCSPCP consultations within the last week Assessment Type Autism and/or ADHD Cognitive Forensic Other Organisation:(Required) Supervision Type (Select all that apply)(Required) Individual Group Select AllName(Required) First Last Date of Birth DD slash MM slash YYYY Email(Required) Phone NumberPlease provide a brief summary of what you are seeking support with:Are there particular areas/themes you are seeking supervision around? Please select your preferences for session type: Telehealth In person Do you have a preference for clinician's gender?(Required)Please identify if you would prefer your session to be with a psychologist of a certain gender. Male Female No preference Do you have a preference of how we contact you? Email Phone SMS No Preference Is there anything further you want us to know?