Child In Mind - Psychological and Learning Assessments

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Thank you for you interest in working with our team! This form is for parents seeking a Psycho-Educational Assessment for their child. We work with the child, parents and schools to develop an assessment plan that addresses the unique needs of the child or teen to help them function better at home, school and in the community.

Process:
1) Submit this form to add yourself to the waitlist for a psycho-educational assessment. Once you submit this form, you are in the queue and will be contacted in order of the waitlist. We thank you for your patience!
2) Following your request, you will receive an email from our clinic within 1- 2 weeks. Please have report cards, previous assessments and custody documents (where applicable) ready or upload here.
3) We will review your request and you will be linked with a member of the assessment team who will lead your child's assessment.
4) Once started, an assessment typically take 6-8 weeks from intake to feedback.
5) At the moment, our waitlist is 8+ months.

**YOU WILL BE ASKED TO EMAIL REPORT CARDS, PREVIOUS ASSESSMENTS AND CUSTODY FORMS. PLEASE COLLECT THEM AND HAVE THEM READY ***

Note:
1) We assess children between 6-16yrs.

2) We conduct assessments in English only at this time as we unfortunately do not have a clinician on our team that is able to provide French services. The assessment tools used in our clinic are developed in English, which is most appropriate for students that study in core English or French Immersion programs. For students, that study in full French programs, it is recommended French assessment tools are employed as this will provide a more accurate assessment of the student's academic profile based on the core language of their primary instructional language.
3) We require consent from all guardians prior to providing psychological services to a youth.
4) We provide services to residents of Ontario only.
5) This form is for psycho-educational assessment only. If you are seeking therapy services, please visit our booking page to view the clinicians with immediate availability to provide therapy support.

We thank you for your patience in this process! We are working hard to serve your family as soon as possible.

Email *

Are you a resident of Ontario? If not, unfortunately we are unable to provide services to your family due to Provincial restrictions. *

Yes, I am a resident of Ontario

No, I am not a resident of Ontario

Are the custody agreements relating to decision making authority? **We require consent from all guardians to provide psychological services to your child** If sole decision making is applicable, please forward documentation to info@childinmind.com *

Guardians are married and live in the same home

Guardians are separated and have shared decision making authority

Guardians are separated, one of whom has sole decision making authority

There is only one legal guardian

I confirm that my child attends school in English or French Immersion, and does not attend a French School. I understand that CIM does not conduct assessments in French at this time, nor for children who study in all French programs. There are 2 reasons for this exemption; 1) due to the age of the norms of the French assessment tools, and 2) not having a clinician working in French on our clinical team at this time. If your child studies in French, we highly recommend seeking an assessor who will test them in French. We invite you to explore this online directory - https://ottawa-psychologists.org/online-directory/

**We hope to offer assessments in French in the future**

I confirm my child attends school in English or French Immersion

Name of Parent 1 *

Phone Number 1 *

Name of Parent 2

Email of Parent 2

I'm interested in *

Psychological Assessment

Learning Assessment

Both

Required

Name of Child *

Age of Child *

Child's Date of Birth *

YYYY

Current academic grade *

Reason for Assessment *

Is your child or any member of your family a current/past client of Child in Mind? If yes, which clinician.

Were you referred by someone? If so, please add name of individual.

We require report cards for the past 3 academic years (if possible), any previous assessments, and court documents regarding custody (if applicable). Please collect these documents and have them ready for when we reach out to you.

A copy of your responses will be emailed to the address you provided.

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