New enquiry

Thank you for reaching out for psychotherapy with Phoenix. This form is designed to for you to briefly introduce yourself and your reasons for seeking therapy, to help Phoenix determine if her services might meet your needs. This form can also be used to enquire about professional mentoring or consultancy with Phoenix. If you proceed to the booking-in stage, there will be an additional longer intake form to complete. Information is gathered in accordance with Phoenix's privacy policy, which is included at the end of this form. Information you include in this form will be accessible by Phoenix and Firebird Psychotherapy admin staff.

As a neurodivergent therapist, my turnaround time for responding to new enquiries fluctuates. I try to respond to enquiries within two weeks wherever possible, but at times of high workload or lowered capacity this may take longer. I appreciate your patience whilst waiting for a reply. If your request is urgent or time sensitive, please feel free to follow up by emailing admin@firebirdpsychotherapy.com if you haven't recieved a response within two weeks.

***Please note: I will be on annual leave from 23rd September until 25th October so there may be a longer delay in responding to enquiries during this time***

What type of service are you seeking? *

Solo psychotherapy (includes other selves)Relationship and/or family therapyProfessional mentoring or consultancy

The name(s) you would like me to use when speaking to you *

Your pronouns (e.g. they/them, she/her, he/him, neopronouns, etc) *

Are you over 18? *

YesNo

If under 18, please provide you age and date of birth *

Email Address (Note: Email is the best way to reach me, and is the most common way I will contact you): *

Phone number *

How did you find out about my services? *

What issues do you hope to talk to me about? *

Is there anything else you would like me to know to help me meet your needs? (e.g. accessibility needs, trauma triggers, religious practices, etc)

I provide psychotherapy via Zoom to people throughout Australia and some overseas countries. For time zone conversion purposes, where will you generally be located during our sessions? (Please note: Because the polyamory, kink, and LGBTQIA+ communities in south-east QLD are small and I am active in these communities, I do not provide psychotherapy for people who live in the south-east Queensland area, as there is too high a risk that our social circles will overlap. I may be able to provide professional mentoring or consultancy to people in this area however). *

What is your post code? *

If overseas, what is the nearest major city in the same time zone as you? *

Please provide the names, pronouns, and ages of any other people who will be attending psychotherapy with you, and/or any other selves you would like me to know about.

Email address(es) of any other adults who will be attending therapy with you (I will include them in my reply to this enquiry) *

Are there times and days that you can or can't attend sessions? (This will help us determine whether my availability will work for you)

At this stage, approximately how often do you hope to have therapy sessions with me? *

Additional details regarding frequency (optional)

What is your preferred session length? *

50 minutes: Available for non-NDIS funded solo psychotherapy only65 minutes: Available for solo, relationship, or family therapy. Also available for NDIS funded therapy when places are available (No NDIS-funded places are currently available)

I understand that Phoenix uses a sliding scale rates chart, and that her services are not eligible for Medicare rebates *

I am aware that Phoenix does not provide forensic risk assessments for people charged with a crime (i.e. Providing a court with an evaluation of re-offending). I understand that these services are outside her scope of practice. *

I am aware that Phoenix may have a waitlist for new referrals (Phoenix will advise whether this is the case when responding to your referral), and that I will need to complete additional paperwork before my first session booking can be finalised. *

I have read Phoenix's bio (available here). *

Is there anything you would like to know about me that isn't included in my bio, before we proceed to the next stage of the intake process?

Do any of the following apply to you? (Please note: There is currently a waitlist for my concession places, but if any of the following apply, you have the option of beginning therapy at middle income rates and being waitlisted for a concession place) *

Health Care Card holderPension Card holderSelf-supporting full-time student paying for own housing and living expenses and not financially supported by parent(s) or partner(s)None of the above

I offer NDIS-funded therapy for self-managed and plan-managed participants, but all of my NDIS places are currently filled and my waitlist for NDIS places is closed. Are you seeking NDIS-funded therapy? *

Yes - self managedYes - plan managedNo

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Privacy Policy

This policy is designed to assure that information gathered by your psychotherapist, S.A. Phoenix (PACFA Reg. Provisional 27171, herein referred to as Phoenix and trading as Firebird Psychotherapy), is used in an appropriate, secure manner, and to provide for access to, and correction of such information. For the purposes of this privacy policy, Firebird Psychotherapy refers to Phoenix herself, and staff employed or contracted by Firebird Psychotherapy for practice administration and management.

If you are seeking to see Phoenix for professional mentoring or professional mentoring or consultancy, any reference to psychotherapy in this privacy policy also applies to those services.

Information Gathered

Firebird Psychotherapy gathers information to guide the care offered to psychotherapy participants. This information includes basic demographic, contact, and payment details (e.g. name, date of birth, address, etc), as well as information relevant to the therapy process. This may include the following:

The nature of the concern(s) for which you are seeking psychotherapy;
Affective, cognitive, and behavioural aspects related to these concerns;
A history of these concerns;
Relevant social and interpersonal history (e.g. Important relationships such as family, friends, professional relationships, partners)
Other information deemed necessary to understand your concerns and other relevant factors
Participant feedback on sessions
Any other information you choose to share with Firebird Psychotherapy

Confidentiality of Information

Generally, all information gathered by Firebird Psychotherapy remains confidential. That is, Firebird Psychotherapy does not disclose your information to anyone else. However, there are several important exceptions to this confidentiality:

It is a professional requirement that Phoenix discusses her clinical work with an appropriately qualified and experienced supervising psychotherapist in a supervisory relationship, and/or with a small group of clinicians in a supervision group. This may include sharing some clinical details about therapy participants, though identifying information is avoided wherever possible. This supervisory relationship must follow Australian privacy laws and any information disclosed during clinical supervision is kept confidential by the supervisor or supervision group.
If Phoenix or Firebird Psychotherapy staff reasonably believe that you or another individual is at risk for significant harm, a moral and ethical obligation exists to act on this information with the aim of preventing such harm. This may involve contacting your nominated emergency contact person/people, a local mental health crisis team, and/or emergency services.
If Phoenix or Firebird Psychotherapy staff reasonably believe that a child is at risk of serious harm then mandatory reporting laws apply. Details of mandatory reporting requirements in Australian states and territories are available here: https://aifs.gov.au/cfca/publications/mandatory-reporting-child-abuse-and-neglect.
If you have not attended a booked session, and Phoenix could not reach you by phone at the session time, Phoenix will attempt to contact you by email to check if you are safe and well. If you have not replied within 3 days, and she still cannot reach you by phone, she will exercise her duty of care by contacting your emergency contact(s) for a welfare check. To protect your confidentiality, she will only share the following details:

She is a service provider to you (not specifying what kind)
You had missed an appointment
She has been unable to reach you since
She is calling/emailing to check if you are okay

If a file is subpoenaed by a court of law, Firebird Psychotherapy is legally required to provide the information specified by the subpoena.
You may instruct Firebird Psychotherapy to share information with another person by making a clear request in writing. Depending on the situation, Firebird Psychotherapy may require you to complete and sign a release of information form.
Session invoices issued by Firebird Psychotherapy and bank transfer information showing on bank statements (e.g. participant names and payment amounts) are accessible to our accountants.

Use of Information

Information gathered by Firebird Psychotherapy is used exclusively for two purposes:

To guide the psychotherapy process; and
For administrative purposes (booking appointments, sending reminders, accountancy etc).

Security of Information

Information provided to Firebird Psychotherapy is held in either secure electronic storage, or in hard copy in a locked filing cabinet. Any cloud-based storage is secured with end-to-end encryption and two-factor authentication. Clinical files (which include information shared in therapy sessions) can only be accessed by Phoenix, unless she is incapacitated. In the event that Phoenix is incapacitated, you will be notified, either by Firebird Psychotherapy staff, or another nominated person. In the event that Phoenix dies or is incapacitated for an extended period, a nominated person may access clinical files only to the extent necessary to arrange alternative care for Phoenix’s psychotherapy participants.

Obtaining Recorded Participant Information

Participant information will only be released in accordance with the ‘Confidentially of Information’ section above. Requests for information may be made in writing and may require completion of a release of information form. Requests should be specific as to the exact information required and will be acknowledged within 14 days. Once a request for information is received, Phoenix (or an alternative nominated person, if Phoenix is incapacitated) will assess whether the request meets the criteria outlined above, and will then collate the requested information in an appropriate manner to ensure adequate and full understanding on the part of the requesting person. Requests for information requiring written summaries or reports, or otherwise requiring a substantial amount of time, may incur fees.

Procedure for Complaint/Rectifying Information

Official complaints or requests to change inaccurate or erroneous information should be made to Firebird Psychotherapy by email. In such cases Firebird Psychotherapy will conduct a review of the information held and make every effort to ensure that such information is accurate.