Psychologist Hawthorn • Booking an Appointment Bita Psychology

Bita Riazati is a psychologist in Hawthorn private practice. You can use this confidential form to make a booking with me. I usually respond within a day.

Contact

Your information will be handled according to privacy and confidentiality requirements.

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.

What do you need to see me about?

Describe your issue/s 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 + a valid referral letter (see checklist under referral)(required) I don't know

YES

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

Highest standards of hygiene and social distancing have been observed at this practice since the beginning of the pandemic. You share a responsibility in keeping this practice safe. So if you have mild cold, flu or other covid-19 symptoms please advise. Usual fees and cancellation policies apply.