\n\t\t\t\t\t

\n\t\t\t\t\n

<\/p>

\n<\/fieldset>\n

\n\t

I'm Referring*<\/strong><\/label>Myself to PsychCentral<\/span><\/span>Someone else to PsychCentral<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n

\n\t
Residential Information*<\/strong><\/label>Residing Address<\/span><\/span>Group Home<\/span><\/span>Hospital<\/span><\/span>Aged Care Facility<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n

\n

\n \n<\/p>\n
NDIS Plan Information\n<\/h4>\n
NDIS Number* <\/span> <\/label>\n<\/p>\n
\n\t
NDIS Start Date*<\/span><\/label>\n\t<\/p>\n<\/div>\n
\n\t
NDIS End Date*<\/span><\/label>\n\t<\/p>\n<\/div>\n
\n<\/p>\n
\n
\n\t
\n\t<\/p>\n\t
Your Information\n\t<\/h4>\n\t
\n\t\t
Participant Full Name*<\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Date of Birth Date*<\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Phone (Home) <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Phone (mobile) <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Your Email* (required) <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n
\n\t
\n\t<\/p>\n\t
Participant Information\n\t<\/h4>\n\t
Does the Participant have an advocate\/guardian?<\/label>
\nYes<\/span><\/span>No<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t
\n\t\t
Participant Full Name*<\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Date of Birth Date*<\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Phone (Home) <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Phone (mobile) <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Participant Email* <\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n<\/p>\n
\n
\n\t
\n\t<\/p>\n\t
Residing Address\n\t<\/h4>\n\t
Street Address <\/span> <\/label>\n\t<\/p>\n\t
\n\t\t
Suburb <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
State <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Post Code <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n
\n\t
\n\t<\/p>\n\t
Group Home\n\t<\/h4>\n\t
Street Address <\/span> <\/label>\n\t<\/p>\n\t
\n\t\t
Suburb <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
State <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Post Code <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n
\n\t
\n\t<\/p>\n\t
Hospital\n\t<\/h4>\n\t
Street Address <\/span> <\/label>\n\t<\/p>\n\t
\n\t\t
Suburb <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
State <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Post Code <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n
\n\t
\n\t<\/p>\n\t
Aged Care Facility\n\t<\/h4>\n\t
Street Address <\/span> <\/label>\n\t<\/p>\n\t
\n\t\t
Suburb <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
State <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t\t
Post Code <\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t
\n\t<\/p>\n<\/div>\n
\n
\n<\/p>\n
\n\t
Are there any access\/reasonable adjustment requirements?<\/strong><\/label>Yes<\/span><\/span>No<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n
\n\t
Participant origin<\/strong><\/label>Aboriginal\/Torres Strait Islander<\/span><\/span>Culturally and Linguistically Diverse<\/span><\/span>N\/A<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n
\n\t
How should PsychCentral contact to book appointments?<\/strong><\/label>Telephone<\/span><\/span>Email<\/span><\/span>Face to face<\/span><\/span>Mail<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n

\n

\n \n<\/p>\n
\n\t
Who should PsychCentral contact to book appointments?<\/strong><\/label>Participant<\/span><\/span>Advocate\/Guardian<\/span><\/span>Referrer<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n
\n\t
Who will sign the Service Agreement?<\/strong><\/label>Participant<\/span><\/span>Advocate\/Guardian<\/span><\/span>Referrer<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n
Does the participant have a preferred appointment day\/time?<\/strong><\/label>Yes<\/span><\/span>No - any time is fine<\/span><\/span><\/span><\/span>\n<\/p>\n
\n\t
Specify preferred day\/s time (Monday to Friday between 9am and 5pm)<\/strong>
\n<\/textarea><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label><strong>Has the participant:<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"has-customer\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"has-customer\" value=\"Got a Criminal Record?\" \/><span class=\"wpcf7-list-item-label\">Got a Criminal Record?<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"has-customer\" value=\"Spent time in prison or a forensic hospital?\" \/><span class=\"wpcf7-list-item-label\">Spent time in prison or a forensic hospital?<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"has-customer\" value=\"Shown aggressive or challenging behaviour?\" \/><span class=\"wpcf7-list-item-label\">Shown aggressive or challenging behaviour?<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"has-customer\" value=\"N\/A\" \/><span class=\"wpcf7-list-item-label\">N\/A<\/span><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"criminal-yes\" data-orig_data_id=\"criminal-yes\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>Please provide details:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"criminal-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"criminal-details\"><\/textarea><\/span><\/label>\n\t<\/p>\n<\/div>\n<p> <br \/>\n<hr \/><br \/>\n \n<\/p>\n<div class=\"one-half\">\n\t<p><label><strong>NDIS support area\/s being requested<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-areas\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"Finding and Keeping a Job\" \/><span class=\"wpcf7-list-item-label\">Finding and Keeping a Job<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"Improved Learning\" \/><span class=\"wpcf7-list-item-label\">Improved Learning<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"Improved Health and Wellbeing\" \/><span class=\"wpcf7-list-item-label\">Improved Health and Wellbeing<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"Improved Relationships\" \/><span class=\"wpcf7-list-item-label\">Improved Relationships<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"School Leaver Employment Support\" \/><span class=\"wpcf7-list-item-label\">School Leaver Employment Support<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"NDIS-areas[]\" value=\"Improved Daily Living\" \/><span class=\"wpcf7-list-item-label\">Improved Daily Living<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label><strong>Details of support required<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"NDIS-details\"><\/textarea><\/span><\/label>\n\t<\/p>\n<\/div>\n<div data-id=\"NDIS-job\" data-orig_data_id=\"NDIS-job\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>How are finding and keeping a job funds managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-job-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-job-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-job-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-job-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div data-id=\"NDIS-learn\" data-orig_data_id=\"NDIS-learn\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>How are improved learning funds managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-learn-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-learn-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-learn-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-learn-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div data-id=\"NDIS-health\" data-orig_data_id=\"NDIS-health\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>How are improved health and wellbeing funds managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-health-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-health-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-health-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-health-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div data-id=\"NDIS-relationships\" data-orig_data_id=\"NDIS-relationships\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<div class=\"one-half\">\n\t\t<p><label><strong>How are improved relationships managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-relationship-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-relationship-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-relationship-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-relationship-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-half last\">\n\t\t<p><label><strong>Are there any restrictive practices in place?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-practices-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-practices-area\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-practices-area\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-practices-area\" value=\"Currently Requesting\" \/><span class=\"wpcf7-list-item-label\">Currently Requesting<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-practices-area\" value=\"N\/A\" \/><span class=\"wpcf7-list-item-label\">N\/A<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div data-id=\"NDIS-school\" data-orig_data_id=\"NDIS-school\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>How are school leaver employment support funds managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-school-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-school-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-school-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-school-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div data-id=\"NDIS-daily\" data-orig_data_id=\"NDIS-daily\" class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><strong>How are improved daily living funds managed?<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-daily-area\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-daily-area\" value=\"NDIA\" \/><span class=\"wpcf7-list-item-label\">NDIA<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-daily-area\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-daily-area\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<p> <br \/>\n<hr \/><br \/>\n \n<\/p>\n<h4>Referrer Details\n<\/h4>\n<div class=\"one-half\">\n\t<p><label>First Name<span class=\"wpcf7-form-control-wrap\" data-name=\"manager-fullname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"manager-fullname\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label>Last Name<span class=\"wpcf7-form-control-wrap\" data-name=\"manager-lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"manager-lastname\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half\">\n\t<p><label> Phone<span class=\"wpcf7-form-control-wrap\" data-name=\"manager-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"manager-phone\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label>Email<span class=\"wpcf7-form-control-wrap\" data-name=\"manager-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"manager-email\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div>\n\t<p><label>Address<span class=\"wpcf7-form-control-wrap\" data-name=\"manager-street\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"Street Address\" type=\"text\" name=\"manager-street\" \/><\/span><\/label>\n\t<\/p>\n\t<div class=\"one-third\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"manager-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"Suburb\" type=\"text\" name=\"manager-city\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-third\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"manager-state\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"State\" type=\"text\" name=\"manager-state\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-third last\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"manager-postcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"Post Code\" type=\"text\" name=\"manager-postcode\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p> <br \/>\n\t<hr \/><br \/>\n \n\t<\/p>\n\t<div class=\"one-half\">\n\t\t<p><label><strong>Are you able to provide PsychCentral with any reports or assessments which may assist in servicing our participant?<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"help-psych\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"help-psych\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"help-psych\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-half last\">\n\t\t<p><label><strong>Please list relevant disability, health and medical conditions<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"list-disability\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"list-disability\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-half\">\n\t\t<p><label><strong>How is the Participant's NDIS Plan managed?<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"NDIS-managed\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NDIS-managed\" value=\"NDIA Managed\" \/><span class=\"wpcf7-list-item-label\">NDIA Managed<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"NDIS-managed\" value=\"Self-Managed\" \/><span class=\"wpcf7-list-item-label\">Self-Managed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NDIS-managed\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-half last\">\n\t\t<p><label><strong>How did you hear about PsychCentral?<\/strong><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"how-hear\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"how-hear\" value=\"Support coordinator\" \/><span class=\"wpcf7-list-item-label\">Support coordinator<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Medical professional\" \/><span class=\"wpcf7-list-item-label\">Medical professional<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Family\/friend\/colleague\" \/><span class=\"wpcf7-list-item-label\">Family\/friend\/colleague<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Previous PsychCentral Group client\" \/><span class=\"wpcf7-list-item-label\">Previous PsychCentral Group client<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Google\" \/><span class=\"wpcf7-list-item-label\">Google<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Social media\" \/><span class=\"wpcf7-list-item-label\">Social media<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"how-hear\" value=\"Directly from PsychCentral\" \/><span class=\"wpcf7-list-item-label\">Directly from PsychCentral<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"how-hear\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div data-id=\"hear-other\" data-orig_data_id=\"hear-other\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<p><label><strong>Please Specify:<\/strong><br 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class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>About PsychCentralPsychCentral is a professional […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":4071,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-5098","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/pages\/5098","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5098"}],"version-history":[{"count":16,"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/pages\/5098\/revisions"}],"predecessor-version":[{"id":6812,"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/pages\/5098\/revisions\/6812"}],"up":[{"embeddable":true,"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=\/wp\/v2\/pages\/4071"}],"wp:attachment":[{"href":"https:\/\/www.psychcentral.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5098"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}