top of page

REFERRAL FORM

At My Advanced Allied Health Services, we make it easy for you to request our services. Simply fill out our referral form below. If you need any help while completing this form or if you prefer to discuss your referral, you can contact our friendly team on either 
1800 622 477 or email at reception@myadvanced.com.au and we can help get you started.

Which Service Type is Your Enquiry Related To?
Services of Interest

By providing your Information, you agree that it will be collected, stored, used and disclosed by My Advanced Allied Health Services in accordance with our Privacy Policy, available upon request. If you do not provide your information us, we may not be able to respond to your inquiry or provide you with the services you request of us or otherwise engage with you. Please don’t provide us with anyone else’s personal details unless you have their permission to do so. 

My Advanced Allied Health Services

Clinic Address: 12 Mary Street, Jimboomba QLD 4077

reception@myadvanced.com.au

Tel: 1800 622 477

Services My Advanced Allied Health Services

Individual Counselling

Relationship Counselling

Family Therapy & Counselling

Psychology

ABN: 95 685 374 494

Opening Hours

Monday: 9am - 5pm

Tuesday: 9am - 7pm

Wednesday: 9am - 5pm

Thursday: 9am - 5pm

Friday: 9am - 5pm

​

Weekends By Appointment

  • LinkedIn
  • Instagram
  • White Facebook Icon
bottom of page