Online Survey Software | Qualtrics Survey Solutions

Thank you for your interest in Swinburne Psychology Clinic assessments.

** Before completing this survey, please review the current psychometric tests: https://www.swinburne.edu.au/research/centres-groups-clinics/swinburne-psychologyclinic/ low-cost-psychological-assessments/.

*PLEASE NOTE THE CURRENT WAIT TIME IS 12 - 18 MONTHS.

*We are not accepting referrals for Autism, ADHD, and Personality (Hollands Self Directed, PAI, and MMPI) Assessments.

The information you provide will help us arrange your test. All questions refer to the individual being assessed. If the assessment is for an individual under 18 years of age, please note that full parental/guardian consent (from both parents, where applicable) must be provided via a separate consent form prior to the test. This will be discussed with you by the clinician if applicable.

Please note that the clinic email may go into your junk mail inbox. When your referral is allocated to a clinician, they will contact you directly for a brief intake session and to schedule dates for the background interview and testing. If you conduct the test elsewhere during the waiting period, please advise us to cancel your referral so we can give another client your position on the waitlist.

Please feel free to contact us on psychclinic@swin.edu.au if you require further information about the process.

Today's date (DD/MM/YY)

Client First name

Client last name

Client gender

Client date of birth (DD/MM/YY)

Client age

Email for client (or parent/guardian/referrer if client is under 18)

Telephone number for client (or parent/guardian/referrer if client is under 18)

Address

Post code

Is this application on behalf of someone under the age of 18?

Yes
No