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About Stress
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Begin StressQuest
Home
About Stress
About Us
Consultation Form
Please note:
All information will be treated confidentially.
Full Name
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Contact Number
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Email Address
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Date of Birth
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Gender
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Residential Address
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Marital Status
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Occupation
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Religious Affiliation
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Name & Contact Number of your General Practitioner (will only be contacted with your approval or when your health or well being is significantly threatened)
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Previous or on-going counselling/therapy/treatment (Have you had any before? What sort? For how long? What was the outcome?)
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If you have been experiencing DISTRESS regarding any of the following, and feel you need help, please tick the relevant box or boxes below, fill out the rest of the questionnaire and then click on the 'submit' button.
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Spiritual matters
Migration
Marriage
Family
Divorce
Separation
Sexual
Loss
Grief
Abuse
Neglect
Retirement
Motivation & Self-esteem
Workplace
Career
Emotional matters
Addictions
Smoking
Weight
Communication
Relationship matters
Time management
Sleep
Anger management
Personal issues
Phobias
Anxiety & Panic
Depression
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Try to put the specific problem you seek help with, in a few sentences.
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Please remember to phone us for an appointment: 0405 364 361
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Yes, I will call for an appointment!
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Submit