EAP Psychology Support Form | DBT Group Therapy

DBT Sydney Adult Adolescent Our Practitioners About DBT

02 7256 7070 Register

Thank you for deciding to use your Employee Assistance Program.

Please fill out the form below, and we’ll contact you to book you in.

First Name *

Last Name

Date of Birth *

Phone number *

Email Address *

Home Address *

Organisation Name *

Contact Person (Manager) *

Employee Number (if applicable)

Employment Location *

Days available for an Appointment *MondayTuesdayWednesdayThursdayFridaySessions are only available from 9am to 5pm, Monday-Friday. Limited Saturday appointments will be available.

Preferred Time for an Appointment *Any timeMorning (9am-12pm)Afternoon (12pm-5pm)

Practitioner Preference *

Preferred Clinic *TelehealthAuburnDrummoyneGordonHornsbyNorth SydneyParramattaPlease select the most convenient for you, however, we cannot guarantee that your session will be held at this location.

Reason for Request (Please check all that apply) *Personal issues (e.g., stress, family problems)Work-related stress (e.g., job stress, conflict)Emotional health (e.g., anxiety, depression)Substance abuseLegal issuesFinancial concernsGrief or lossOther

If other, please specify:

Consent & Confidentiality *

I understand that the information I provide on this form will be treated confidentially and shared only with the EAP provider for the purpose of arranging services. I consent to the EAP services and understand that any counselling sessions are confidential and will not be shared with my employer. I acknowledge that my participation is voluntary.

Suite 1.01/32 Delhi Road
Macquarie Park NSW 2113
Near North Ryde Metro

Speak with our team

02 7256 7070

logicloungepsychology.com.au

DBT skills groups

Adult and Adolescent DBT Skills Programs
Next intake 16 October 2026

Adult DBT Adolescent DBT