Surrey

Surrey Clinic location:

Clinic Address
#12 – 15243 –  91st Avenue
Surrey, BC  V3R 9K2

Phone Number
1.604.584.3450

Fax Number
1.604.584.3457

Email Address
surrey@ableclinic.ca

Intake Form - Surrey Clinic

Notice: ABLE Clinic is proud of its role as a teaching clinic training the next generation of practitioners. ABLE Clinic hosts residents, practicum students, and pre-registration supervised practitioners who are all duly supervised by registered professionals. You may be offered to receive services from a supervised practitioner, or you may be asked about the indirect participation of trainees through observation.
 
Please complete the following intake form to initiate the referral process. Upon receipt, our intake team will contact you within ten days. Please also check your email junk folder. If you have not heard back from our office within two weeks of the date of submission, please give us a call at 604-584-3450. There may be a wait for assessment or intervention services. Please note our Surrey office's current estimated wait times: Psychoeducational assessment 9-11 months, 6+ years ASD assessment 12-18 months, Under 6 years ASD assessment at least 18 months. Thank you for your patience and we look forward to supporting you.
 
Is there another email that you would like correspondence sent to as well (e.g., another parent)?
Address line, City, Province, Postal code
We are required to have consent from all legal guardians in order to provide services. If this is a concern, please let us know as soon as possible.
Required by the College of Psychologists of BC, the BC Association of Clinic Counsellors, and the College of Speech and Hearing Health Professionals of BC.
Required by the College of Psychologists of BC, the BC Association of Clinic Counsellors, and the College of Speech and Hearing Health Professionals of BC.
If sole guardianship has not been established then both parents are required to provide signed consent for services (eg. parents are separated or divorced). Please note that ABLE Clinic is not able to provide psychological services if guardianship is in active dispute and all parties do not consent to services.
In the event we need to ask a teacher to participate in the assessment, please provide us their name and contact information (preferably email).
Supervised practitioners often are available with shorter wait times and most bill a lower hourly rate than registered professionals which can reduce the cost of services. Supervised practitioners are not yet registered with the College of Psychologists of BC and are closely supervised by Registered Psychologists here at ABLE Clinic. You will not be charged for the cost of this supervision.
Please put "N/A" or equivalent, if there is no relevant history for this item or the next.
Providing this information will help us assign the appropriate clinician to support/assess your child.
 * Please note, we cannot guarantee the confidentiality of information transmitted through e-mail including this intake form.  If you are not comfortable with this limitation, please contact our office and we will provide an alternate submission method.