Book Now- Westshore Location Please fill out the information below and a representative will contact you with further instructions. Seeking a Psycho-educational, ADHD Assessment, or Career Assessment?Fill in the boxes below and a representative will connect with you to complete the booking. Choose location. Please note that only one submission request per family/child is accepted. Additional requests for booking and/or bookings submitted for multiple locations will result in a delay to be contacted.SidneyParkside (Downtown Victoria)Westshore (Langford)Please select what service you are after:*Psycho-educational AssessmentAdult Psycho-educational AssessmentAdult ADHD AssessmentCareer AssessmentInformed consentIntact family or non applicableSeparated with full parental rightsCo-parenting with consent from my child's other parentCo-parenting and needing to obtain consentOur Agency practices Informed Consent which requires the legal parent(s) or guardian(s) to authorize Consent for Services. Are you an intact family or co parenting at separate addressesParent/Guardian Name(s) or Self if making a personal booking.*Parent NameParent Name Email Address* Phone Number*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Child's Name* First Last Child's Date of Birth or Self if making a personal booking.* Month Day Year GradeName Of School AttendingIs your child's school a Francophone school?NoYesIs this a reassessment? If so what year was the previous assessment?Please also note if the previous assessment was conducted through our office or somewhere else. Notes/CommentsAnything you would like to pass along regarding the assessment? If you called the office first to discuss please make note of the phone call. Would you like to be added to the cancellation list?If assessment appointments at your selected location open in the time before your intake, we will contact you to offer the availability. Cancellations are first come, first serve. We will contact the cancellation list in order of submission; if the assessment works for you, please let us know ASAP. If you cannot take a cancellation availability, you will remain on the cancellation list.Is this going to be covered by a third party payer?Note, this does not refer to medical insurance plans. Third party payers may include Jordan's Principle, Variety, SelfDesign, Heritage Christian, Regent Christian, Kleos, etc. Seeking Counselling Support? Book now with one of our counsellors. Go to our "counselling" page and click on the location you would like to book. Online and in-person options are available. Use the Book Now button on the team page for counselling services. NameThis field is for validation purposes and should be left unchanged.
