Bookings

Please complete this form before your first appointment so we have your details on file.

Contact Bita directly on 0433 781 919 for bookings, or you can use the form below.

Booking Form

All information you share is handled privately and confidentially.

First Name: *

Last Name:

Date of Birth:

Phone Number:*

Email Address*

Street Address:

Suburb:

Availability Information

Who is this appointment for? *

If you're booking for someone else, you can let me know.

MyselfFamily MemberCoupleChild

Who is the parent or caregiver?

OK - Thanks for letting me know.

We can meet with both of you to talk about your concerns, and we'll also explore whether individual sessions are more helpful for you or your partner. Yes, I'd like to begin with a couple session.

Bita does not offer joint sessions for shared relationship concerns, as individual issues require privacy for proper exploration. She offers one-on-one sessions for individuals to discuss their relationship, while partners can seek separate therapists for their own concerns.

Are you filling this form for a family member? If so, please tell me why:* DisabilityLanguage problemsOther

OK - Thanks for letting me know.

Reason for Seeking Help:

Your Preferred Appointment Time: *

Before 5 PMEvening Appointment (After 5)Next Available Appointment

Preferred Location:

Do You Have a Valid Referral?*

How Did You Hear About Me?

Bita will call you to confirm a time.

Bita Riazati
You are welcome to fill out this form or call me on 0433 781 919 to book a time in Hawthorn or Belgrave. We will begin with a session to talk.

Bita Psychology

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