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Intake Form - Psycho-educational Assessment

I'm seeking services for: 

How did you hear about us?
Do you have extended health benefits coverage?
Do you have any other funding coverage?
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Reasons for seeking a psycho-educational assessment

What problems have been concerning you? Please provide a brief description for each applicable selection:

Thanks for submitting!

Thank you for completing this form. We will review your information and contact you as soon as possible. Please note that due to the high demand for services, there may be a delay in our response. Service availability depends on clinician availability and client needs. Should you have any questions in the meantime, please don’t hesitate to contact us at


Warm regards,

Beacon Psychology Team

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