Waitlist Form Question Title * 1. Your name Question Title * 2. Partners Name (if applicable) Question Title * 3. Your Contact Details Email Address Phone Number Question Title * 4. Do you need an afterhours appointment? (Kate sees clients on weekdays up to 4pm) Yes No Question Title * 5. What type of appointment would you like to book? Individual Couples Clinical Supervision Question Title * 6. What is your issue of concern? Relationship Issues Grief Depression/Anxiety Life/Career Concerns Not Sure Other (please specify) Question Title * 7. Anything else you would like Kate to know? If you need immediate support please call Lifeline on 131 114, contact the Suicide Call Back Service on 1300 659 467 or at suicidecallbackservice.org.au or give Beyond Blue a call on 1300 224 636. Submit