Gold Coast (07) 5551 0251
Brisbane (07) 3102 1366
admin@cbtprofessionals.com.au

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(07) 5551 0251
(07) 3102 1366

Dungeons and Dragons Group Registration Form

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Social and Emotional Group Therapy Programs
Dungeons and Dragons Group Registration Form

* Required

Face challenges, solve puzzles, and shape your story through interactive storytelling and imagination!

Open to young adults aged 16 years and older. NDIS Participants Welcome

1. Attendee Name *

2. Enquirer Name

Complete if the attendee is under 18 years old.

4. Contact phone number *

Please enter enquirer's phone number if the attendee is under 18 years old.

6. Contact email address *

Please enter enquirer's email address if the attendee is under 18 years old.

5. Is the Attendee a current patient at CBT Professionals or Solutions for Life Psychology? *

receive updates

7. Billing *

Private
GP Referral
NDIS Funded - Plan
NDIS Funded - Self

8. What days would suit best for attendance over the School Holidays? Select all applicable. *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

9. What timeslot could you attend? Select all applicable. *

9am - 12pm
12pm - 3pm
3pm - 6pm
5pm - 8pm

10. Do you have any specific access requirements or considerations for participation?

Optional

11. Would you like to receive updates regarding this program in the future? *

Send us a message

Name *

Message Comment address

E-mail address *

Phone Number:

Comment or Message *

THREE CONVENIENT LOCATIONS

HELENSVALE

Homeworld Helensvale
Shop 51, 502 Hope Island Road
Helensvale, Qld 4212

(07) 5551 0251

NERANG

Prana Centre
Suite 3, 832 Southport-Nerang Road
Nerang QLD 4211

(07) 5668 3490

MOUNT GRAVATT

Mt Gravatt Medical Precinct
SE 105, 1808 Logan Rd
Upper Mount Gravatt QLD 4122

(07) 3102 1366

CONTACT US

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Phone:

Comment or Message *

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