New Patient Registration

Which psychiatrist are you registering with? * 🛈

Prof Richard Harvey

Dr Catherine Maud

Dr Maud's waiting time from registration is currently approx 4 months.

Reason for wanting to see Professor Harvey *

ADHD Assessment

WPATH Support for Gender-Affirming Treatment

Any Other Reason

If you have not been invited to complete this form by text, please make contact by e-mail or phone (03 5292 1644) before registering as a new patient.

Dr Harvey is currently experiencing a very high demand for assessments and has very limited capacity.

Dr Harvey is currently experiencing a very high demand for assessments. Earliest appointments are now in February 2025 for surgery dates from March 2025 onwards.

Reason for wanting to see Dr Catherine Maud *

Women’s reproductive mental health (menstrual, perinatal, menopausal)

Obsessive Compulsive Disorder (OCD)

Any Other Reason

To see Prof Harvey for other reasons, please make contact by e-mail or phone (03 5292 1644) to discuss your referral. If your referral has not been accepted by Prof Harvey, please do not proceed any further.

Dr Maud prioritises referrals for women's reproductive mental health & OCD but will also consider accepting referrals for "other reasons".

Have you ever been seen by Prof Harvey or Dr Maud before? *

Yes

No

If you have been seen before you will already have a patient login and DO NOT need to register again, you can simply book online. To access the patient booking login click here: https://patientportal.clinictocloud.com.au/login

Your username is your e-mail address, and you should have the password in a previous e-mail from your psychiatrist's practice or you can reset your password at the login.

Registering again as a new patient will only delay your ability to book an appointment.

First Name (as shown on your Medicare card) *

Last Name (as on your Medicare card) *

Preferred Name

Address *

Suburb *

State *

Post Code *

Email Address *

Please re-type your e-mail address *

Please monitor your junk/spam folder regularly to ensure you don't miss an e-mail from us. For unknown reasons, hotmail.com and outlook.com often filter messages from us to spam. You can also add "info@telepsych.online" to your contacts or whitelist.

Mobile Number *

Date of birth: * +

Do you identify as: 🛈

Aboriginal or Torres Strait Islander	LGBTQIA+	Culturally or Linguistically Diverse (CALD)
Interpreter required (please specify below)

Gender *

Male

Female

Non-binary

Different identity (please specify) Different identity (please specify)

What are your pronouns?

She

He

They

Other (specify) Other (specify)

Medicare Number *

Medicare Ref. *

Medicare Expiry

DVA File Number (if you have one)

The following fees apply for Medicare-funded consultations with Prof Harvey.

New patient assessment requiring ongoing care - $540, after rebate, out of pocket $284.

New patient assessment with a management plan for your GP (Item 291 requested by GP) - $728, after rebate, out of pocket $284.

Follow-up appointments - $178, after rebate, out of pocket $96.

For full details of fees please click here.

The following fees apply for Medicare-funded consultations with Prof Harvey.

New patient WPATH assessment and report (single consultation) - $540, after rebate, out-of-pocket $96 (if you have not seen another psychiatrist in the past 12 months). Patients in rural and regional areas (as defined by the Federal Government) will be bulk billed with no out-of-pocket cost.

If you have seen another psychiatrist who has claimed "Item 291/92435" in the past 12 months, then the out-of-pocket will be $255.

I am aware that medical gender affirmation is generally irreversible. I am aware that 1-3% of patients regret the decision to transition and that de-transitioning may be expensive, traumatic or even impossible. I accept full responsibility for my decisions concerning accessing gender-affirming treatment. *

Yes

I consent to the use of my Medicare number for billing and claiming by the practice, and to access my 'My Health Record' to support clinical care. * 🛈

Yes

I understand that fees apply for consultations and that payment must be made on the day of the appointment. * 🛈

Yes

I have read, understood and consent to the practice privacy policy. *

Yes

Reasons for requesting an appointment * 🛈

What gender-affirming procedure are you planning to undergo?

What is the name and clinic of the surgeon you are seeing?

What date is the surgery booked for? 🛈

Do you also require a report to support the release of your Superannuation? *

Yes

No

Please download the Compassionate release of superannuation – Report by registered medical practitioner form, complete section A (including your signature and date) and upload the completed form as an attachment. The ATO report will be completed on the day of your consultation.

If you have a referral letter or other relevant documents, including school reports required for ADHD assessments, please upload them here (if you have a smartphone, take a photo).

If you have many (>10) school report files, or the files are large (>100Mb) or not in PDF format, please request an "Upload link" below, and a link will be sent by e-mail.

You can also share a folder containing your reports via Google Drive, Onedrive, Dropbox etc - paste a link to the folder in the box above. 🛈

If you have a referral letter or other relevant documents, including school reports required for ADHD assessments, please upload them here (if you have a smartphone, take a photo). 🛈

School reports (from Year 3/4 to Year 11/12) are required for an ADHD assessment. *

School reports already supplied

School reports uploaded above

Please send a secure upload folder link

I have pasted a link to my school reports above.

I don't have my school reports

School reports are required to proceed with an ADHD assessment. Please carefully read the information here.

We will not be able to process your new patient referral until school reports (or pre-approved alternatives) have been provided

If you have a referral letter, or other relevant documents, please upload them here (if you have a smartphone take a photo):

I confirm that I am the person named above and I am registering on my own behalf. * 🛈

Yes

If you have questions about registering as a new patient, please either phone (1300 617 685), e-mail (info@telepsych.online) or visit our website (telepsychiatrist.online).

Privacy note: Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including the DHS privacy policy.