Your Counselling Ltd.

Assessment Referral (Professionals)

For physicians, therapists, schools and other professionals referring a client for a psychological assessment.

Thank you for thinking of us for your client. The form takes about 5 minutes, and your client does not need to do anything until we reach out.

Our intake team reaches out to your client to recommend the right assessment and book an intake appointment. With your client’s written consent, we can share the report and recommendations with you. Every report is signed by a Registered Psychologist.

Helpful to include:

  • The question you would like the assessment to answer
  • Relevant history, and any current treatment or medication
  • Previous assessments, and roughly when they were done
  • Anything that would help your client feel comfortable, such as accessibility needs

Our assessments include ADHD, psychoeducational, gifted, diagnostic mental health and PDD cognitive assessments, with autism assessments planned for early 2027. See all assessments and fees.

If you have any issues or questions about this form please contact our office.

About you (the referring professional)

Your Name
For example: family physician, pediatrician, psychiatrist, therapist, teacher, accessibility advisor.

About the client

Client Name
Client Date of Birth
Consent

The referral

Assessment requested. Check all that apply.
Would you like a copy of the report (with the client's written consent)?

This form is not monitored for urgent concerns. If you or someone else is in immediate danger, call 911. For mental health crisis support, call or text 988.