Complete the on-line or print version of our referral form. Then either submit via email or fax the referral to our office. Thank you for choosing West Coast Psychological Services.
Our receptionist will connect with you within one business day of receiving your request. If necessary, Dr. Klancnik (or a designated Registered Psychologist from WCPS) will conduct a free phone consult with you to determine if an assessment would meet your needs.
If you would prefer to fax or mail your referral form, click here to download.
Note: Although every effort is made to ensure on-line security, confidential or sensitive information should not be sent via any on-line mode of communication. Do not include any sensitive or confidential information here. Personal details will be discussed either in-person or over the phone.
Please bring any information you feel may be useful (i.e. resume, previous assessments, health records, educational record...).
Note: Although every effort is made to ensure on-line security, confidential or sensitive information should not be sent via any on-line mode of communication. If you have sensitive information that you would like us to be aware of prior to the assessment, we suggest you include it in a hard copy of the referral form and fax it to our office or contact the psychologist directly and discuss details either in-person or over the phone.
If you have a comment, compliment or complaint, we would like to hear from you. Click here.
Note: If the client being referred is a minor, please bring proof of your relationship to (or status with) the client, so that appropriate consent forms can be completed at the intake appointment.
