New Patient Registration

Which psychiatrist are you registering with? * 🛈
Reason for wanting to see Professor Harvey *
Dr Maud's waiting time from registration is currently approx 4 months.
Reason for wanting to see Dr Catherine Maud *
If you have not been invited to complete this form by text or via your GP,  please make contact by e-mail or phone (03 5292 1644) before registering as a new patient.
 
Patients must be under the age of 40 years to be considered for an ADHD assessment. Priority is given to patients 16-26 who are still engaged in education.
 
To see Prof Harvey for other reasons, please make contact by e-mail or phone (03 5292 1644) to discuss your referral.
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? *
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.
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Do you identify as: 🛈
Gender *
 
What are your pronouns?
 
The following fees apply for Medicare-funded consultations with Prof Harvey.
 
New patient assessment requiring ongoing care - $519, after rebate, out of pocket $251.
New patient assessment with a management plan for your GP (Item 291 requested by GP) - $679, after rebate, out of pocket $251.
Follow-up appointments - $175, after rebate, out of pocket $94.
 
The following fees apply for Medicare-funded consultations with Prof Harvey.
 
New patient WPATH assessment and report (single consultation) - $519, after rebate, out-of-pocket $91 (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 $252.
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. *
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. * 🛈
I understand that fees apply for consultations and that payment must be made on the day of the appointment. * 🛈
I have read, understood and consent to the practice privacy policy*
Do you also require a report to support the release of your Superannuation? *
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.


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

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