Are you a new client or existing client?

New Client with no existing appointment

Existing Client or has initial appointment booked

Client's Name

First Name

Last Name

Client's Phone Number

Client's Email Address

Which clinician does this wait list request relate to?

What is the Client's availability for a next appointment?

How soon would the Client prefer the next appointment to be?

Consent & Acknowledgement

I understand that being added to the Wait List does not guarantee a next appointment within my preferred timeframe

I understand that I can also check Book Online at any time to see what appointments are available

Today's Date

Please do not proceed with this request.
Please instead submit a New Client Enquiry form.

Wait List Request

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