Booking Form. Answers to Your Questions. Let us get to know you!

If you require emergency assistance immediately call:

9-1-1
For other health assistance, please contact your doctor

Welcome! My team and I are excited to meet you and together discover your child’s unique needs. We strive to provide you with clarity, peace of mind, and the confidence to set your child on the right path. The first step is to tell us about yourselves so we can better assist you.

Our data collection is compliant with Canadian privacy laws and equipped with state-of-the-art encryption and security features. Your privacy is our top priority.

-- Dr. Ryan Chan and Team

Have you visited the "Services", "About" and "FAQ" pages of our website? You may find your answers quicker by clicking here.

Do you have further questions about our services?

Yes No

Questions

Please enter the email where you would like us to reply to your question(s)

If you are a resident of British Columbia, you may be eligible for a public assessment through the BC Autism Assessment Network, referred by your General Practitioner or Pediatrician.

A private autism assessment:

Shortens wait-times. Our first appointments are in 3 weeks.
Get clarity and peace of mind sooner
Earlier autism intervention
School support: BC Ministry of Education autism funding and support for each child diagnosed with ASD
Community funding: Up to $6,000 annually for children 6 – 18 – Ministry of Children and Family Development ASD funding.

In British Columbia, an average private ASD assessment ranges from $2500 to $3700. Some places charge even more.

Dr. Chan provides expert autism assessment. An ASD assessment with Dr. Chan typically costs $2699. *An additional charge may be added for extra file review or meetings beyond a typical assessment.

Do you accept grants or extended health beneifts?

Good news! We accept grants (e.g. Variety Children's Charity)

Extended health benefits generally do not cover Dr. Chan's services as a Psychiatrist, but in some cases they may. Please call your extended health provider to confirm if they cover services by a medical doctor.

Do you have further questions about the cost of a private autism assessment?

Yes No

Questions about the cost of a private autism assessment

Ready to book a private assessment?

Yes I'm still thinking about it

If you would like us to stay in touch about our services, please ENTER YOUR EMAIL HERE. (Remember to CLICK SUBMIT below to send us your question):

Please complete the following Booking Form

A word about your privacy. Our data collection is compliant with Canadian privacy laws and equipped with state-of-the-art encryption and security features. While we take every measure to secure your privacy, it is important you understand and consent to the limitations of online security before sending us any sensitive, private or confidential information

Please review, complete and submit the Consent to Use Electronic Communication Form before submitting any confidential or personal information. Download it here and use our secure file transfer found below. Your privacy is our top priority.

Booking Form. Your answers will help us better understand your child's needs. We will be in touch once we have reviewed your responses.

Patient's first name

Patient's last name

Personal Health Number (PHN)

Patient date of birth

Street Address

City

Postal Code

First name of Parent/Guardian completing form

Last name of Parent/Guardian completing form

Contact email address

Primary phone number

Preferred language

English Other

If Other is chosen, specifify which language is preferred:

Would you want an English interpreter during the assessment with Dr. Chan?

Yes No

Do we have your permission to leave voice messages?

Yes No

Is the above youth aware and in favor of Dr. Ryan Chan and his Team providing psychiatric and autism assessment?

Yes No

Unfortunately, we cannot provide assessment unless the above youth is aware and in favor of being assessed by Dr. Ryan Chan. Would you like some recommendations for next steps?

Yes No

For the above child, are ALL Parents/Guardians with medical decision-making rights AWARE of Dr. Ryan Chan and his Team providing mental health and private autism assessment? Per family law in BC, all parents/guardians must be made aware of Dr. Chan's assessment unless one parent has sole guardianship. Note that primary residence does NOT constitute sole guardianship.

Yes No

For the above child, are ALL Parents/Guardians with medical decision-making rights IN FAVOR OF Dr. Ryan Chan and his Team providing mental health and private autism assessment? Per family law in BC, all parents/guardians must provide consent for Dr. Chan's assessment unless one parent has sole guardianship or is given final medical decision making ability when parents/guardians disagree. Note that primary residence does NOT constitute sole guardianship.

Yes No

Unfortunately, we cannot provide assessment unless all Parents/Guardians with medical decision-making rights consent to your child being assessed. Would you like some recommendations for next steps?

Yes No

Do Parents/Guardians live together?

Deceased/Never invovled Yes No

Do all Parents/Guardians wish to participate in our assessments?

Yes No

All parents are asked to complete a Booking Form. You will be contacted once booking forms are complete. Please indicate your choice below

Guardians jointly completed this Booking Form Alternate Guardian will submit a separate Booking Form

Alternate Guardian First Name

Necessary if guardians live separately and share guardianshp

Alternate Guardian Last Name

Necessary if Guardians live separately and share guardianship

Alternate Guardian email address

Necessary if Guardians live separately and share guardianship

Alternate Guardian phone number

Necessary if Guardians live separately and share guardianship

Are all Parents/Guardians comfortable participating in joint assessment sessions and family meetings?

Yes No

We are regrettably unable to offer separate assessment meetings or family meetings. Would you like recommendations of providers who may be a better fit with your needs?

Yes No

Do all parent(s)/guardian(s) wish to add a no cost mental health assessment to improve a stand-alone autism assessment? This mental health assessment searches for conditions that might mimic autism (E.g. ADHD, anxiety, developmental delay, etc). It allows Dr. Chan to better understand your child and does not delay the wait time for an ASD assessment.

Yes No

Has your child's physician already submitted a referral to us?

Yes No Unsure

Do you, and if applicable your youth 16 years of age and older, give us your consent to seek a referral from your child's Physician? While we can send a referral request on your behalf, we recommend that you make an appointment with your physician to discuss the referral

Yes No

Very well, we can still proceed with a stand-alone, private autism assessment without the free mental health assessment. Do you have any questions about the mental health assessment?

Yes No

Questions about the free, supplemental mental health assessment

Has your child visited their General Practitioner, Nurse Practitioner or Pediatrician in the past 6 months?

yes no

**IMPORTANT** Please arrange a medical visit for your child with the above physician. This is necessary before proceeding with our services.

It ensures that your child’s physician is up to date with your child’s health. It also allows for a physician referral for a supplemental, free mental health assessment (if applicable).

Practitioner's LAST NAME

Practitioner's FIRST NAME

Practitioner's MIDDLE NAME

Middle name is helpful when full name is common

City of practice

Office fax

Secure communication with your child's physician

Choose the option that represents how your child MOSTLY communicates.

No words, just sounds or movements Single words Two word phrases 3 word phrases including a verb (action word, e.g. "give", "go", "stop") 2 or more phrases joined by the word "and", "but" Full sentences, ie. fluent speech None of the above

Is your child affected by any of the following

Significant hearing loss

Significant blindness

Language delay

Diagnosed with "Intellectual Disability" or "Global Developmental Delay"

Genetic disorder

Great difficulty sitting and/or following instructions

None of the above

Please list significant medical conditions

Enter N/A if none

Please provide further detail

Would any condition in the above 3 sections or other conditions make virtual or in-person assessment difficult?

yes no maybe

How would you like Dr. Ryan Chan and his Team to help?

How did you hear about us?

Please upload our requested forms here

Files You can add multiple files

Add file

Please upload a file

CLICK "SUBMIT" BELOW to send us this form. We will be in touch within 2 business days.

Thank you for visiting Dr. Ryan Chan Autism Assessment and Screening Services where we help you get clarity.

THIS BANNER WILL DISAPPEAR WHEN THIS FORM IS COMPLETE.

Your information will be encrypted.

Booking Form. Answers to Your Questions. Let us get to know you!

If you require emergency assistance immediately call:

Welcome! My team and I are excited to meet you and together discover your child’s unique needs. We strive to provide you with clarity, peace of mind, and the confidence to set your child on the right path. The first step is to tell us about yourselves so we can better assist you.

A private autism assessment:

Do you accept grants or extended health beneifts?

Please complete the following Booking Form

Please upload our requested forms here

CLICK "SUBMIT" BELOW to send us this form. We will be in touch within 2 business days.

THIS BANNER WILL DISAPPEAR WHEN THIS FORM IS COMPLETE.

If you require emergency assistance immediately call:

Dr. Ryan Chan

Autism Expert and Pediatric Psychiatrist