Bulk-billed Psychology sessions application

It is important to note:

To complete this application, you will need to have a valid GP referral letter and Mental Health Treatment Plan (MHTP) to be eligible for bulk billed sessions. We take only a limited number of bulk billed clients, and therefore assess applicants on a case by case basis. You will be informed of the outcome of your application within 2-3 business days.

Steps to your application:

1.    Complete your details within this form to be considered for bulk-billed psychology sessions.

2.    Upload your GP referral letter and MHTP

3.    Submit your application

All information is confidential as per our Privacy Policy . If you have any questions, our team is here to help via hello@mymirror.com.au

Do you have a Mental Health Plan & GP Referral? *

YesNo

A Mental Health Plan is a support plan obtained from a GP that gives you access to Medicare rebates and bulk-billed sessions for up to 10 psychology sessions a year.

A referral will be required for us to finalise your application. You can access an MHP appointment quickly and easily from home via Qoctor with bulk billed appointments.

Do you have your document ready to upload now? *

YesNo

You will need to have your documents ready to upload to continue with the application.

Do you have your documents already uploaded and validated on your My Mirror account?

YesNo

A referral will be required for us to finalise your application. Please contact your referring GP to obtain a copy of your current Referral letter and Mental Health Care Plan before continuing to submit an application or book with Qoctor for an online appointment.

Please upload your MHTP and your referral letter (we accept doc, pdf, jpeg files) *

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Have you had any Psychology session this year? *

YesNo

How many sessions have you had? *

Do you already have a My Mirror Account? *

Yes, I have an accountNo, I don't have an account yet

First Name *

Last Name *

Phone Number *

Date of Birth *

Email *

What is your address? *

Street address *Street address line 2

City *

State *Please selectACTNSWNTQLDSATASVICWA

Postcode *

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Do you have a valid Medicare card? *

YesNo

It is a Medicare requirement that you have a valid Medicare card to access bulk billed sessions.

Please provide your Medicare card number *

Please provide your Medicare card reference number *

Are you of Aboriginal or Torres Strait Islander Decent? *

YesNo

Are you currently employed? *

YesNo

What is your employment status? *Full Time (+25hrs/week)Part Time (<25hrs/week)Casual (<10hrs/week)None

What is your family status? *SingleCouple - single income Couple - dual income Single parent - dependants Family - dependants - single income Family - dependants - dual income

What is your total average monthly household income? *

Do you have a Healthcare concession card issued by Australian Government Services *

YesNo

Please provide your Healthcare card number *

Are you currently experiencing financial hardship? *

YesNo

Please provide additional details to support your application.

I declare that the information provided above is true and accurate *

What is your Medicare listed name?

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