New Referral Form 
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 waitlist is confirmed. We will be in touch when assessment appointments become available, or to request further information if needed. 

Please be aware that this document is private but not protected to the level needed for health information. Please do not disclose a lot of detail about your concerns. If you are uncomfortable completing this Google Form, please print it and complete it by hand, then email contact@whatifpsychology.ca to be sent a secure password protected link where you can upload it.
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Email *
Child/Teen's First and Last Name *
Child/Teen's Date of Birth *
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Child/Teen's Gender *
Name of School Child/Teen attends *
Parent #1 First and Last Name *
Parent #1 Email  *
Parent #1 Phone Number *
Parent #2 First and Last Name
Parent #2 Email
Parent #2 Phone Number
Child Custody and Decision Making *
If you were referred to What if Psychology by someone, please indicate their name. 
Concerns leading to needing an assessment *
Any other relevant information?
A copy of your responses will be emailed to the address you provided.
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