We are adhering to government regulations and have appropriate measures in place to protect our team and clients. We continue to offer telehealth services through telephone and Microsoft Teams, to clients who are unable to attend appointments in person.

Please contact us on 1800 258 487 to arrange your appointment.

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Home › Online EAP Booking › Booking Request Intake Form

Booking Enquiry

Please note that if you are in distress or you require an urgent appointment, please call our reception desk on 1300 307 912. If you are at risk of harm, please call 000

Your Details

All fields with * are required

First Name*

Last Name*

Contact Number*

Email Address*

Preferred Session Type*

No Preference

Telephone Counselling

Video (Online) Counselling

Face-to-Face Counselling

If face-to-face counselling: Preferred Location:

State

Suburb - WA

Suburb - NSW

Suburb - VIC

Suburb - ACT

Suburb - QLD

Preferred Day of the Week*

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred Time of Day*

Preferred Contact Method*

Phone Call

Email

Additional attendee appointment details

Appointment type – who is going to attend the appointment?*

Individual

Couple

Teen (13+)

Child (12 and under)

Is the person attending the session a private client, an employee, or a family member of an employee?*

Employee

Family member of an employee

A private client

Private client refers to a referral from a GP. As a private client, fees will be incurred per session and paid by the individual. If you obtain a mental health care plan from your GP, you may be eligible for a Medicare rebate

Employer name (Please enter the full company name)*

First name and Family Name of the client*

Date of Birth (DD/MM/YYYY)*

Gender*

If employee: Marital status*

Single

Married/De Facto

Separated

Divorced

Widowed

Prefer not to say

If employee: Employment status*

Full time

Part time

Contract

Casual

Temporary

Other

If employee: Occupation*

If employee: Business unit / Division / Department*

If employee: Length of Service*

If employee: Referral source – did someone in the organisation /department suggest that you call us?*

Self-referral

HR

OHS

Manager/Supervisor

Co-worker

Family Member

Union

I am a returning client

Other

If employee: How did you hear about the EAP service?*

Briefing

Brochure

Card

Induction

Internal Newsletter

Co-worker/Manager

Intranet/Internet

Family member

Poster

Union

Session number - which session will this be?

Emergency Contact Name*

Emergency Contact Number*

Additional Comments

Psychological Services

Clinical Services

Organisational Services
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- Common Use Agreement (CUA)
- Cultural Change & Change Management
- Surveys
- Coaching and 360 Feedback
- Outplacement and Careers
- Personality Assessment

Injury Management

Vocational Rehabilitation
Manual Handling
Physical Rehabilitation

Injury Prevention

Occupational Safety & Health
Ergonomics
Duties and Work Role Analysis

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PeopleSense Pty Ltd
2 Bagot Road,
Subiaco Western Australia 6008

T: 1300 307 912
F: (08) 9388 9006
E: [email protected]

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