1 2 3 4 5 6 7 8 9 10 If you would like to request an appointment with one of our therapists, please fill out the following questionnaire to help us assess your needs. Completing this form does not guarantee that you will receive treatment. FUNDING SOURCE Funding Source * Private Pay Sensitive Claims (ACC) PRIVATE PAY Private Consultation Fees are charged at an hourly rate and are dependent on the profession of the therapist. Please check with your individual therapist to ascertain their fee. Psychologist $150 - $260 Psychotherapist $120 - $200 Counsellor / Arts Therapist $95 - $195 Rates are GST exclusive CAPTCHAWe'd like to prevent automated spam submissions. Please demonstrate that your are not a robot.