I'm a new patient - Altitude Mind Clinic

How to Book Your First Appointment

Prior to booking your first appointment with Altitude Mind Clinic please fill out the form below and attach your referral letter from your GP. This will be reviewed by our administration team and you will be contacted within three business days with instructions on how to book your appointment. Please ensure you read our clinic policies before submitting your form.

Read Clinic Policies

Altitude Mind Clinic | Telehealth Mental Health Care

New Patient Enquiry

"*" indicates required fields

If you already have a referral from your GP, please upload it here. If you do not have a GP referral, we can discuss options with you when we speak. We accept referrals to other clinics. The referral does not need to be addressed to our clinicians or our clinic.

How did you hear about us?*

Google

Other Search Engine

Social Media

Another Existing Patient of the Clinic

Other (eg. GP Referral)

Name*

First Last

Email*

Phone*

Address

Street Address City State

Please upload a copy of your referral:

Max. file size: 64 MB.

How can we help?

Please do not submit sensitive personal or medical information through this form.

Signature*

I have read, understood and agree to Altitude Mind Clinic’s clinic policies as outlined on the website.