If you have been sent to this link you have been identified as a new member of the Australian DBT Institute team (Gold Coast DBT Clinic, Essentia Health Brighton, DBT Retreats and/or DBT Assist (Telehealth Service).

To ensure the most suitable referrals to you from our intake and administration team, please complete the below form with as much detail as you can so we can finish setting up your professional profile!

Thank you for choosing to work with our team. We are looking forward to working with you!

Personal Information

If you have a seperate number for clients to contact you please provide this number. We do not expect clinicians to have a seperate number nor do we expect you to have a direct line for clients to contact you. Please state NO PHONE NUMBER TO SHARE if you do not wish to share any phone numbers with individual clients!
We hope we never need to use this. In the case of an emergency our clinic director will contact your NOK if needed.
Please include your Account Name, Bank, BSB and Account Number

Clinical Practice

Please provide the qualifiction and any abbreviations used when communicating qualifications
Select all populations above that you do not wish to receive referrals for
Select all populations above that you do not wish to receive referrals for

Professional Profile

Click or drag a file to this area to upload.
Please provide a professional looking photo for promotion on our website
Please list the day(s) of the week and times you plan to be working in our clinical services (GC-DBT, Essentia and/or DBT Assist)
Limit of 300 words

Supporting Information

Number provided on your certificate of registration
Click or drag files to this area to upload. You can upload up to 3 files.
Click or drag a file to this area to upload.
Professional indemnity insurance
Click or drag a file to this area to upload.