JOIN OUR TEAM

Name

Email Address

Phone

Location (town and country)

Website (if you have one)

Social media (if you have business accounts)

Are you are Psychologist or Social Worker? Are you are Psychologist or Social Worker? Clinical Psychologist Registered Psychologist Mental Health Social Worker Social Worker Other (please elaborate below)

How many years have you been working as a fully qualified Psychologist / Social Worker?

How many years have you been offering online / telehealth counselling?

How many years have you been working in private practice?

Please describe (briefly) your education and training

Please describe (briefly) your work experience

Who are you registered with? Who are you registered with? AHPRA AASW

What is your AHPRA / AASW registration number?

Do you have a Medicare provider number? Do you have a Medicare provider number? Yes. I have a provider number for the location I intend to use to conduct telehealth sessions Yes, however I will need to apply for a new provider number for my home location Yes, however I will need to apply for a new provider number for a location other than my home address Not yet, but I am eligible to obtain one No

Does your insurance cover you for online Psychology services? Does your insurance cover you for online Psychology services? Yes Not yet, but I can organise it No

Do you have an ABN? Do you have an ABN? Yes Not yet, but I can organise one No

If you already have an ABN, what is it?

Who do you work with? Who do you work with? Children Adolescents Adults Families Couples

What are your areas of interest? What are your areas of interest? Depression Anxiety Stress Trauma Sleep difficulties Perinatal mental health Life transitions Coaching Other (please provide info below)

How many client sessions would you like per week? How many client sessions would you like per week? 2-5 6-9 10-14 15-19 20+

How tech savvy are you? How tech savvy are you? I am easily confused with technology I am somewhat comfortable with technology I am comfortable with technology I am somewhat confident with technology I am very confident with technology

Please tell us why you would like to join our team at Awake Psychology.

Anything else you would like to share with us?