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P H O E N I X
HEALING ARTS THERAPY

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Contact Us

At Phoenix Healing Arts Therapy, we believe in the power of connection. Feel free to reach out with any questions or to book an appointment.

116 Snell Grove, Oak Park, VIC 3046

+61 0416 603 100

Self Referral Form

You do not need referral from a GP you can self referral yourself, your children or parents.

Please fill the form to start your art therapy journey or simply contact to us.

First name

Last name

Phone

Address

Birthday

Day

Month

Year

With whom are you currently living? (Please list names, ages, and relationship)

Please list any physical health and mental health conditions that may be relevant to your situation.

Do you have any accessibility needs or preferences (e.g., mobility, communication, sensory support)?

Yes

If it's yes, please describe.

GP’s Name:

GP’s Clinic and Contact Details:

Have you previously consulted with any mental health professionals?(tick all that apply)

Counsellor/Psychotherapist

Art Therapist

Psychologist

Psychiatrist

What was helpful in those consultations?

What was unhelpful?

What prompted you to make this appointment?

Would you like to explore any of the following?

Anxiety

Anger

Family and/ or parenting

Communication

Managing conflicts

Confidence /Self-esteem

Depression

Trauma

Separation or divorce

Trust

Stress

Are you making this referral on behalf of someone else? If so, what is your name & phone number & relationship to the person being referred?

Is there anything else about you, your background, or your current circumstances that you feel is important for me to know to best support you?

Which days and hours do you prefer for sessions?

Get in touch

First name*

Last name

Email*

Phone

Write a message

Contact us

artfts13@gmail.com

0416603100

116 Snell Grove Oak Park VIC, 3046, Australia

Accessibility Statement

Terms & Conditions

Refund Policy

Phoenix Healing Arts Therapy

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Contact Us

Self Referral Form

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