Complete the on-line or print version of our referral form. Then submit the referral form to our office via email . 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.
