Welcome!

Emergency Assistance

If this is an emergency, call:

Vancouver Island Crisis Line: 1-888-494-3888
911

Here is the process:

Fill out this application form.
Your form will be reviewed within 2-3 business days.
You will receive a response by email or phone (according to your preference specified below).

Wait Times:

Assessments – Currently scheduling assessments in July 2025.
Therapy – Currently scheduling new therapy clients for June 2025.

IMPORTANT - Please note that this secure web form:

DOES NOT – initiate a professional relationship.
DOES – Comply with Canadian and Provincial Privacy Laws (HIPPA, PHIPA, AND PIPEDA).

Child/Youth/Young Adult's Information

First name

Last name

Age

Gender

Primary email contact for client

Parent or Guardian Information

If the Child/Youth is under the age of 17, please fill out the following Parent/Guardian information.

First name

Last name

Phone number

Email address

Relationship to child

Address

I am interested in the following services:

Please select one or more of the following

Therapy Services

Psychoeducational Assessment

Mental Health Assessment

Neuropsychological Assessment

CLBC Eligibility Assessment

Reasons for Visit

Describe the reasons for seeking psychology services. Please specify if you are seeking an assessment, therapy and/or consultation.

For therapy services, describe any goals or outcomes you hope the child/youth/young adult to achieve.

For assessment services, what questions are you hoping to have answered?

Are parents together?

Together Separated

If separated, please indicate if both parents agree to these services?

Yes No Unsure N/A

Is there anything else regarding this child/youth's personal history that I should be aware of?

Your information will be encrypted.

Welcome!

Emergency Assistance

Child/Youth/Young Adult's Information

Parent or Guardian Information

I am interested in the following services:

Reasons for Visit

Emergency Assistance

Dr. Drew Halliday, R.Psych.

Clinical Psychological and Neuropsychological Services