Assessment Request

Assessment Request - Psychoeducational Assessment (not Autism Spectrum Disorder)

Thank you for contacting What if Psychology about a psychoeducational assessment. Once this form is completed, it is time stamped and your place on the list for an assessment is confirmed. We will be in touch within two business days with information about booking an assessment for this summer, or to request further information if needed. If we do not hear back from you after 2 emails and a phone call, your name will be removed.

Child/Adolescent First & Last Name

Date of Birth

School Name

Parent #1 Name

Parent #1 Phone Number

Parent #1 email address

Parent #2 Name

Parent #2 Phone Number

Parent #2 email address

Referred by:

(Complete this if a friend or medical professional referred you to What if Psychology)

Concerns that have led to needing an assessment

Any other relevant information?

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Assessment Request

Assessment Request - Psychoeducational Assessment (not Autism Spectrum Disorder)

Assessment Request - Psychoeducational Assessment (not Autism Spectrum Disorder)

Kate Davidson, M.A., C.Psych.

Psychologist, What if Psychology