Practice Address Shop 7, Level 1, 19 Young StreetSouthport QLD 4215 Reception Hours 8:00am - 5:00pm Tuesday - Friday Contact (07) 5627 0551 Follow Us Instagram Facebook Linkedin Please enable JavaScript in your browser to complete this form.Name *Email *Phone NumberHow would you like to work with Melissa? *TherapyBreathworkSupervisionCoachingA mix of all of the above!1. What are your top 3 goals for the next 6 to twelve months? *2. What are the 3 biggest challenges in your life right now? *3. What is your motivation for working with Melissa specifically? *4. Would you consider working with another clinician if they had availability sooner than Melissa?YesNo5. How do you think Melissa can help you? *6. How did you hear about Melissa? *7. How motivated are you to do the work required to improve your life? *Not motivated at all.I feel stuck, I am not sure.Hell yes, sign me up!8. Do you have any risk issues that would deem you unsuitable to wait for an appointment with Melissa such as suicidality, serious self harm, or intent to harm another person? If so, please telephone 000 or 1300 MH CALL.Submit