Day & Evening Request a Consultation with Bita

All requests and enquiries can be discussed with me in a consultation. Note: this is not an emergency service. If you need urgent assistance please ring 000, your local police station or lifeline crisis counselling on 13 11 14.

—Please note (update 25/10) — I offer appointments based on my initial assessment of your needs and availability. I will review the information and I will contact you when a time becomes available. Due to increasing demand for psychology across Victoria at the moment, there is currently a delay, so if you do not hear from me after a few days, please ring and leave a message.

Self-referral form

The secured self-referral form (below) can be completed by the patient. Please provide some information about your situation or problem in your own words, so that I can determine how I may be able to help you.
Please review the process and fees sections to familiarise yourself with how I work. I usually respond to requests within 2-3 business days.
Bita Riazati Psychologist and Clinical Psychoanalyst

CONFIDENTIAL FORM

You can request a consultation with Bita Riazati by filling this form. Your information will be handled in accordance with relevant privacy and data protection laws.

Contact details

First name(required)

Last name(required)

Phone number(required)

Bita will leave a voice message if she is unable to reach you.

Street address(required)

Suburb(required)

Email(required)

By submitting your information, you’re giving Bita permission to email you.

Reason: what do you need to see me about?

Describe your presenting problem or issues of concern:(required)

Preferred appointment time (Mon – Thur)(required) Morning (9 to 11 am)

Afternoon (12 to 4 pm)

Evening (5 to 10 pm)

Any – I need the next available appointment

How did you hear about me?(required)

Has your GP created a Mental Health Care Plan + valid referral letter? (review the referral letter checklist under fees)(required) I don't know

YES

I filled out the form on my own. I hereby give my consent to be contacted by Bita. I understand she may request further information to assess my enquiry / referral.(required)

COVID-19-stage4 Highest standards of hygiene and social distancing have been observed at this practice since the beginning of the pandemic. You also share a responsibility in keeping this practice safe. So if you have any mild cold, flu or similar symptoms you must always get tested, you must advise me, and you must not attend the practice. Usual fees and cancellation policies apply.