Julia Ryan Psychology - Assessment Intake
  • Assessment Intake Form


    Welcome to the Julia Ryan Psychology Assessment Process

    Thank you for your interest in working with us. Before you begin, please review the following information regarding our assessment intake process.

    Time Commitment

    This is a comprehensive intake package. From start to finish, it takes about 1 hour to complete the form.

    We value your privacy and take active measures to protect your personal health information. Due to these protective measures, your progress is not automatically saved.

    Please ensure you have a stable internet connection and set aside the required time to fill out this form. Your progress will be lost if you exit this webpage before submitting.

    We also recommend you fill out this form on a device with a screen larger than a phone, but it is not strictly necessary.

    Timeline

    You'll hear back from us within 1 week of submitting this form. During that time, our clinical director, Dr. Ryan, performs a comprehensive review of your form submission to ensure a strong understanding of your needs and appropriate matching to available clinicians. You will get the opportunity to request to work with a specific clinician or to prioritize lowest cost or lowest wait.

    Once our initial review is complete, we'll email you to discuss next steps.

    Important Updates


    • Assessments are currently open for {ageRangeString}.
    • We are booking in 4-6 months.
    • In April 2026 we are moving to 310 Beechgrove Avenue in Westboro.
    • Dr. Ryan is not currently accepting new clients directly. However, Dr Ryan provides ongoing supervision and/or consultation to all clinicians on our team, so families can feel confident that any assessment at Julia Ryan Psychology will meet their needs.

      Dr. Ryan is expected to reopen a limited number of assessment spots in the summer for bookings in the fall, with all in person appointments and testing supported by psychometrists. Families are welcome to check back at that time if they are specifically interested in working with her.

    Your Information


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  • [H] CLIENT AGE

  • [H] CLIENT TEXT / STRINGS

  • [H] CLIENT LANGUAGE

  • [H] INSURANCE

  • [H] FILE UPLOADS

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  • Format: (000) 000-0000.
  • Your distance from Julia Ryan Psychology


    It looks like you live 50 kilometers or more from our office; please be mindful that certain steps in our our assessment process require in-person attendance.

    If you'd like to inquire further before proceding, please email admin@drjuliaryan.ca

  • Client Information


    Throughout this form, the individual to be psychologically assessed will be referred to as the Client.

    The information below will be used to create the Client's official file. Please enter the details (name, date of birth, etc.) for the individual who is receiving the services.

    If you are submitting this form for someone else, do not use your own name or date of birth in these "Client" fields. Doing so will create an incorrect file and will require us to resend the form for correction.

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  • Ineligible Age


    Unfortunately, due to high demand and long wait times for certain ages, our assessment intake is currently only open to individuals who are {ageRangeString}. Assessment intake submissions are closed for individuals outside of this age range and you will not be able to complete or submit this form.

    If the Client is within this age range, please verify that you've entered the correct date of birth above (Format: Day-Month-Year).

    We apologize for any inconvenience this has caused.

    Referral links

    Here are clinics in Ottawa offering psychological assessment services that we recommend:

    • Patchwork Psychology (ages 5 and under)
    • Centre Dimensions (ages 5 and under)
    • Jeremy Doucette (all ages)
    • Ivanova and Associates (adults)
    • Melodie Lemay-Gaulin (virtual only, adults)
    • NPSCSPN (children and adolecents, French included)
  • Residency Requirement


    We are only licensed to serve residents of Ontario, or Quebec if they can travel to our office in Ottawa. If you are not a resident of either province, we cannot administer a psychological assessment to you or your dependent.

  • Eligibility


    LANGUAGE

    Our diagnostic tests are standardized for English speakers. Administering them to a Client who is not fluent in English, or attempting to translate questions during the assessment, compromises the clinical validity of the results.

    As a result, we cannot guarantee accurate findings for Clients who are not fluent in English. 

    Further, we no longer carry materials to test academic functioning in French. Our assessments are usually not suitable for those attending school in French primarily.

    To ensure every Client receives a reliable psychological assessment, we currently limit our assessment services to primarily English-speaking Clients who attend school in English. We apologize for the inconvenience.

    We recommend our colleagues at this clinic for assessments in French: NPSCSPN.

  • For those submitting this form on a Client's behalf


    Clients aged 16 and older

    Clients aged 16 and older are required to participate in the completion of this form. We recognize that assistance may be needed, and it is appropriate for a caregiver or partner to help. However, the client's direct involvement is essential.

    A team member at Julia Ryan Psychology can also be made available to meet with the client to help complete the forms. You can contact the clinic at 613-699-0825 or admin@drjuliaryan.ca

  • Custody and Consent to Services


    By law, we require consent from all parent(s) and/or legal guardian(s) who hold legal custody and medical decision-making authority before services can begin. Mutual consent is assumed for parents who are married and living together.

    In situations where parents or legal guardians are separated or divorced, it is clinic policy to obtain consent from all individuals with legal decision-making rights and to include them in relevant communication related to intake and services. As part of this process, we will request contact information for the second caregiver so that they can be provided with consent forms and an opportunity to share relevant information.

    While not all parents choose to actively participate in services, consent and inclusion at the intake stage are required to ensure ethical practice, informed decision-making, and compliance with professional and legal standards.

    If your family situation is complex and this policy does not fit well with your circumstances, we encourage you to contact us before completing this form so we can discuss your situation and determine whether our clinic is the right fit. You can reach us at admin@drjuliaryan.ca or 613-699-0825.

  • Consent from both legal custodians is required if separated or divorced

    If the child's legal custodians (i.e. caregivers, parents, guardians, etc.) are separated or divorced, we require consent from both caregivers. In these cases, we will email a consent form to the other legal custodian once your assessment request is submitted.

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  • Informed Consent


    Instructions


    The next several sections of the form contain important information about the services that are offered by Julia Ryan Psychology. As a clinic providing regulated health services, it is required that you provide informed consent.

    We value your privacy and take active measures to protect the Client's personal health information. Due to these protective measures, your progress is not automatically saved. Your progress will be lost if you exit this webpage before submitting.

    Please read this information carefully to make sure that you understand it. 

    Contact Us

    If you have any questions about this form, we encourage you to reach out to us.

    You can contact the clinic at 613-699-0825 or admin@drjuliaryan.ca if you have questions about the information in this form while completing it.

    Assessment Overview


    Our comprehensive psychological assessment ("assessment") involves the evaluation of a person's mental health and learning profile to determine strengths, needs, required supports, and any applicable diagnoses. They involve interviews, administration of tests and questionnaires, obtaining information from informants or other sources, discussion of results, and preparation of a report. These assessments therefore include psychoeducational, developmental, and mental health components.

    Diagnoses and Recommendations

    Assessments may not lead to a diagnosis; however, strengths and needs are identified in all cases, along with appropriate recommendations.

  • Assessment Team


    Assessments are completed by registered psychologists and highly trained clinicians working under the close supervision of our Clinical Director, Dr. Ryan. Each assessment is supported by experienced clinical assistants and psychometrists who contribute to intake, standardized testing, behavioural observations, and scoring.

    All members of our team receive ongoing training and participate in regular consultation and supervision with Dr. Ryan. She is actively involved in overseeing clinical decision-making, case conceptualization, and report development across the practice, ensuring a high standard of care and consistency in our assessment process.

  • Informed Consent


    Risks and Benefits of Services


    Participating in mental health services, including psychological assessment, carries both potential benefits and inherent risks. It is important to be aware of these before beginning the process. A thorough understanding can help you make an informed decision and be better prepared for the experience.

    Risks Associated with Assessment


    Emotional Discomfort

    The assessment process itself can be stressful. Discussing personal and sensitive issues, being in a clinical setting, meeting new people, and engaging in various testing activities can evoke uncomfortable or distressing emotions such as anxiety, sadness, or frustration.

    Fatigue and Overwhelm

    Assessments can be lengthy and mentally demanding. It is common to experience fatigue, a sense of being overwhelmed, or emotional sensitivity both during and after assessment sessions.

    Results

    The findings or diagnoses may be surprising, confusing, or distressing. The client and others involved in the service may not agree with the conclusions, or may find the results difficult to accept. There's also a possibility that the assessment may not provide clear answers as hoped.

    Symptom Management

    An assessment is a diagnostic process, not a direct form of treatment. While it provides recommendations, it does not in itself address the presenting issues. For example, the recipient of services will not learn skills or strategies directly during an assessment. The process can sometimes heighten awareness of issues without immediately providing a solution.

    Limitations to Impact

    The assessment report does not guarantee that other providers (doctors, therapists, teachers, etc.) will follow the recommendations. Similarly, it does not automatically grant access to academic accommodations, funding, or other resources, as eligibility is determined by those institutions and not by the assessment itself.

    When a report is shared with a school, employer, or another medical provider, they may have their own internal processes for recognizing the diagnosis and associated needs. They might require their own assessment or a review by their affiliated professionals.

    Privacy and Confidentiality

    While all psychological services are bound by strict confidentiality, sharing the final report with third parties (such as schools or employers) means that your personal health information will be disclosed. It is crucial to consider who will have access to this information and how it might be used.

    Potential for Misinterpretation

    There is a risk that the results of the assessment could be misinterpreted or oversimplified by others, leading to labeling or stigmatization.

    Benefits Associated with Assessment


    Diagnostic Clarity and Understanding

    Gain a comprehensive and deeper understanding of your symptoms, behavioral patterns, and the nature of your presenting concerns. An assessment can often provide a clear diagnosis, which can be a relief and a starting point for effective intervention.

    Identification of Strengths and Needs

    The process does not just focus on challenges. It will also identify your unique cognitive, emotional, and personal strengths, alongside areas where more support or intervention is needed.

    Feeling Validated and Understood

    For many, the process of being thoroughly listened to and having their daily challenges systematically explored can be a validating and empowering experience. It can provide a sense of feeling truly seen and understood.

    Actionable Recommendations

    A key outcome is a tailored set of recommendations for evidence-based treatments, educational strategies, and specific interventions to address your unique profile of strengths and weaknesses. We do offer additional follow-up services for support with implementation of recommendations.

    Advocacy and Communication Tool

    The final report serves as a formal document that provides a common language for the client, family, and various professionals (therapists, doctors, educators) to understand and discuss your needs. This documentation can be a powerful tool for self-advocacy in educational, occupational, and healthcare settings.

    Foundation for Effective Treatment Planning

    A thorough assessment provides a roadmap for future therapeutic interventions, allowing for more targeted and effective treatment planning with mental health providers.

    Improved Self-Awareness

    The insights gained from the assessment process can lead to a greater understanding of needs, fostering self-compassion and providing new ways to approach challenges.

    Managing Risks


    In light of both benefits and risks, we are committed to minimizing risks by:

    • Providing a safe and supportive environment
    • Using evidence-based assessment and treatment approaches.
    • Engaging in ongoing professional development.
    • Maintaining ethical and professional boundaries
    • Explaining the process and results as clearly as possible and offering different methods of communication
    • Discussing additional risks directly to inform choices
  • Informed Consent


    Our Duty to Maintain Confidentiality and its Limits


    Providers at Julia Ryan Psychology have a duty to protect your confidentiality, meaning that any information you share with your provider will not be disclosed to third parties without your informed consent except in specific circumstances as outlined below.

    There are certain situations in which your provider has a legal and ethical duty to disclose information without your consent. In these instances, your provider will, whenever possible and ethically appropriate, discuss the disclosure with you beforehand, explaining the circumstances that necessitate it.

    These limits to confidentiality include:

    1. Imminent Harm to Others: If you disclose an intent to cause imminent, serious bodily harm to another identifiable individual, we have a duty to protect that potential victim.
    2. Imminent Harm to Self: If you disclose an intent to cause imminent, serious harm to yourself, we have a duty to protect your safety. Child Abuse or Neglect: If we have reasonable grounds to suspect that a child (under the age of 18) is being, or is at risk of being, abused, neglected, or is otherwise in need of protection, we are legally obligated to report this information to the Children's Aid Society.
    3. Sexual Abuse by a Healthcare Provider: If you disclose information about the sexual abuse of a client by another healthcare provider, we have a duty to report this to the provider's regulatory college or professional association.
    4. Abuse/Neglect in Long-Term Care: If we become aware of abuse, neglect, or maltreatment of a resident in a long-term care facility, we are required to report this to the Director at the Ministry of Long-Term Care.
    5. Other circumstances where confidentiality may be breached:
      • College Audits: As members of the CPO, our files may be subject to periodic audits to ensure compliance with professional standards.
      • Court Subpoenas: In the event of a subpoena issued by a court of law, we may be legally required to disclose certain contents of your file.
  • Informed Consent


    Privacy, Confidentiality, and Access to Information


    At Julia Ryan Psychology, your privacy and the confidentiality of your personal health information (PHI) are of paramount importance. This statement outlines how we manage your PHI, your rights regarding access to that information, and the limits to confidentiality we must uphold in accordance with the College of Psychologists of Ontario (CPO) guidelines and the Ontario Personal Health Information Protection Act (PHIPA).

    Secure Practice Management System

    We use OWL Practice, a secure, web-based system, to store and manage client records. This system is encrypted and utilizes servers exclusively located in Canada, ensuring compliance with Canadian privacy laws.

    Information Stored

    Client records include a comprehensive collection of your PHI, such as appointment details, billing documents, session notes, contact information, reports and test results, communications between you and your clinician, and any other client-related documents. Data Encryption, Backups and Security: All data in OWL is encrypted both in transit and at rest. Practice data is routinely backed up to protect sensitive client information and ensure compliance with PHIPA. Your data cannot be replicated or stored on servers or locations outside of Canada.

    Limited Access

    Access to your file is restricted to your provider and other authorized members of our clinic team, all of whom are bound by strict confidentiality agreements.

    Data Retention

    Clinical files are archived for 10 years from the date of your last service, or for 10 years after you turn 18 if you were a minor when you last received services. After this retention period, your file will be securely destroyed in accordance with PHIPA guidelines.

    Privacy Policy

    A detailed privacy policy is available for your review. Please contact julia@drjuliaryan.ca to request a copy.

  • Right to Withdraw Consent


    You have the right to withdraw your consent for assessment at any time, without penalty.

    You will still be charged, and required to settle, fees for work completed prior to your decision to withdraw, and results may not be interpretable depending on the stage at which you withdraw.

    In addition, a record of service is maintained according to relevant health information guidelines even if withdrawn from services.

  • Informed Consent


    Mutual Exchange of Information


    To ensure the highest quality of care and accuracy in the Client's assessment, it is often helpful for us to consult with professionals currently or previously involved in the Client's care. 

    This includes:

    • Teachers*
    • Doctors
    • Psychologists
    • Therapists
    • Counsellors

    In order to do so, we require the client or client's legal guardian to provide consent for us to contact these individuals.

    * If the Client is currently enrolled in or recently graduated from primary or secondary school.

  • Informed Consent


    Right to Access


    With limited exceptions, the Client has the right to access any record of their personal health information that we maintain and to request copies of that information. Information collected from others (e.g., caregivers, teachers) about the Client is considered part of the Client's Personal Health Information (PHI). As such, the right to access includes this information.

    The Client is always the person who is being assessed, including, for example, teens. If they are deemed incapable of consenting for themselves, a substitute decision maker (e.g. a caregiver) would consent to the sharing/access of information. Usually, clients above the age of 12 are considered capable to consent and obtain information.

    If the Client or Client's legal guardian believes the personal health information is inaccurate or incomplete, they have the right to request corrections. We will review your request and make corrections where appropriate. There may be nominal fees associated with preparing your information in advance of its release.

    Exceptions to Access

    There are some exceptions to the right of access:

    • Raw data from psychological assessments which requires professional interpretation and can only be shared with other qualified professionals.
    • Information provided in confidence by a third party.
    • Information that could reasonably be expected to result in serious harm to your treatment or recovery, including yourself. Any decision to withhold information on this basis will be documented in your file.
    • Information that caregivers or other third parties share about themselves or others (e.g. not the Client) is also protected by confidentiality and will not be shared with the Client or another without explicit permission. In most cases, that person's information will be removed (severed) before providing access.

    Youth Consent and Access

    If you are the custodial caregiver or guardian of a child or adolescent who has been deemed capable of consenting to services by their clinician (i.e. a mature minor), you may not access the personal health information of that youth unless:

    • The youth has provided explicit consent for you to access such information, or
    • The youth has been deemed incapable of consenting to the service on their own and you are the substitute decision maker (usually a custodial caregiver with access to medical information and decision making capacity - this may be a shared duty).
  • Informed Consent


    Telehealth


    Telehealth includes videoconference, telephone, or even text/email forms of communication. Patients must be physically located in Ontario or Quebec during a telehealth session.

    Risks and Benefits

    The benefits of telehealth include increased access to services (e.g. reduced travel, more flexible schedules, etc., and, in times of public health concern, access to services in the absence of alternatives.

    The risks of telehealth include potential for miscommunication with certain nonverbal information missing, limitations to some activities that are difficult to do remotely, and technology and environment related risks to privacy (e.g. someone overhearing you in your house, unsecure networks, etc.

    Preliminary research has shown that interventions delivered remotely have similar efficacy to those delivered in person.

    Privacy and Confidentiality

    Privacy and confidentiality continue to apply to telehealth services, and as such special considerations are made to ensure these standards are upheld. Videoconference sessions take place through various platforms with enhanced and ensured security, compliant with PHIPA. Both parties involved in a telehealth session should be in a private room to protect privacy.

    Technological Considerations

    To maintain appropriate service, a secure, strong wifi connection and use of a laptop is necessary. If these elements are missing, there will be increased technology interruptions that will interfere with the session. If another person is present in the room, they must present themselves to the clinician before beginning. In the case of severe issues with technology during a videoconference, phone is used as back up.

    Emergencies

    In the case of an emergency, such as a crisis or concern for safety, your provider needs to know where you will be located during the telehealth sessions and the name of an emergency contact. Your provider will collect this information at the start of each telehealth session.

    Email Correspondence

    Any contacts with clients that are clinical in nature must be stored in the client's file. In addition, there are privacy concerns with regard to the use of email. Email is not secure; emails can accidentally be sent to the wrong person, they may be hacked, and they may be stored on an individual's computer or browser history. For these reasons, use of email to share confidential information (updates, clinical issues, documents) is at the client's discretion.

    Secure Messaging with Owl Practice

    A secure message system is available through the Owl Practice portal to encourage heightened security of personal information. To send your provider a secure message in Owl Practice, use the "messages" tab.

  • Informed Consent


    Use of Technological Platforms


    To enhance the quality and efficiency of our services, clinicians at Julia Ryan Psychology may use certain technological platforms. We are committed to minimizing the use of external platforms for storing PHI. Where external platforms are used, we review the privacy policies and practices to ensure those platforms are compliant with privacy regulation.

    Categories of Platforms We May Use

    1. Secure Communication Platforms: Google Workspace for Google Meets, communication between team members, and emails.
    2. Digital Signature Platforms: For electronic signing of documents (e.g. DocuSign, Adobe Sign, etc.)
    3. Note-taking support platforms: For recording of sessions that allow for transcription and support with writing notes (e.g. Klarify, Heidi)
    4. Tools to support parts of report-writing (e.g. reverb)

    Your Right to Choose

    By signing this form, you are providing general consent for the use of external platforms by the clinic for purposes limited to those written above, though you retain the right to refuse any specific tools. Please inform us verbally or in writing if you do not consent to any data related to your service being used with external platforms so we can discuss and document the decision and implications for service.

  • Informed Consent


    Family Involvement and Collaboration


    We understand the importance of working with families and aim to involve family members in assessment procedures when it is necessary and beneficial for the Client.

    For children and youth under the age of 16, we strongly encourage both caregivers to participate to help us gain a comprehensive understanding of how the child functions in different environments and to ensure both caregivers have equal access to sharing their perspective and understanding the scope of service. If you anticipate any issues with this, it is important to inform us.

    For all Clients, inclusion of family members does not mean that family members have a right to the results or the information shared by others during the course of the assessment.

    Personal health information belongs to the Client. Therefore, the decision to share this information rests solely with the Client or their Substitute Decision Maker (e.g., a parent, guardian, or caregiver for those unable to consent).

    If your provider believes that disclosing specific information (beyond the limits of confidentiality described above) to other family members would be beneficial to the Client or to the assessment process, they will discuss these benefits with the Client directly to encourage their informed consent for disclosure.

    Confidentiality extends to each individual who meets with a provider at Julia Ryan Psychology. For example, a child has the right to confidentiality with their provider, including the right to decide what information (if any) is shared with their caregivers about their treatment, subject to the limits of confidentiality described above.

    We prioritize the Client's autonomy and will only disclose information with their explicit permission, when ethically and legally permissible.

  • Informed Consent


    Ottawa-Carleton District School Board Waiver


    This section only applies to Clients currently attending Ottawa-Carleton District School Board (OCDSB) schools.

    Please note that some clinicians at Julia Ryan Psychology are also employees of the Ottawa-Carleton District School Board (OCDSB).

    The OCDSB requires that Clients who attend OCDSB schools, and are working with one of our clinicians who is also an OCDSB employee, understand the following points:

    1. The Client or their legal custodian is aware that a similar service may be available through the OCDSB, free of charge.
    2. Services sought through the OCDSB are subject to eligibility requirements.
    3. Your clinician can provide information to facilitate exploring service options at the OCDSB.
    4. If a clinician from our practice (who is also an OCDSB employee) is asked by an OCDSB school to provide consultation or supervision for a Client they have seen in private practice, they must declare a conflict of interest. In this scenario, the clinician will request that a different OCDSB psychology staff member handle the required school-based consultation or supervision.
  • Informed Consent


    Contact Us


    You can contact the clinic at 613-699-0825 or email admin@drjuliaryan.ca if you have questions about the information in this form while completing it.

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  • End of Section: Informed Consent

  • Fees and Payments


    Fee Structure


    The fees at Julia Ryan Psychology vary by clinician and service.

    For Assessment Services

    Assessments completed by psychologists are charged hourly and vary in cost depending on the presenting issue and the measures required, ranging from $2500 to $4500. Our practice also uses psychometrists and assistants for various parts of the assessment.

    In some cases, a student, trainee, or supervisee may be leading the assessment at a reduced fee, which will be offered and communicated before beginning.

    Billable Fees

    All service fees apply to direct client contact, as well as non-contact clinicial work such as writing reports, scoring tests, consulting with other professionals, and completing forms. 

    Payment

    Fees can be paid either by credit card or e-transfer to info@drjuliaryan.ca. If by e-transfer, the payment is due immediately upon receipt of the invoice.

    We require a credit card on file for all clients.

    Late Fees

    A late penalty of $5 per day will apply for late payments which will be applied at the next invoice. Subsequent sessions will not be scheduled until previous balances are paid.

    Cancellations and Missed Appointments

    If the client cancels the appointment without 48 hours of advanced notice or does not show up, we will apply a late fee of 50% of the session fee. For in-person assessment sessions that are several hours, the client will be charged for the equivalent of two hours.

    Exceptions will be made for illness, self-isolation, or other extenuating circumstances at the discretion of the clinic.

    Privacy and Access to Information


    Privacy legislation regulates who can access a Client's information and under what circumstances. If someone other than the Client or guardian is paying for service, they are permitted to communicate with the clinic regarding billing matters, invoices, and insurance claims. However, they are not entitled to accessing the Client's health information including details about scheduled appointments, treatment plans, or clinical findings.

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  • Fees & Payment


    Insurance


    Mental health services are not covered by the Ontario Health Insurance Plan (OHIP). Many extended health benefit plans cover psychological services. It is your responsibility to check your coverage before initiating services. 

    Depending on your insurance policy or work arrangement, health insurance and employee assistance programs (EAPs) may not cover the entire cost of our mental health and psychological assessment services.

    We can perform direct billing with some insurance companies, including:

    • Canada Life
    • Coughlin
    • Desjardins
    • Equitable
    • First Canadian Insurance
    • IA Financial
    • Johnson
    • The Public Service Health Care Plan (PSHCP)
    • And others

    If you or your child are covered under any of the eligible plans above, or would like to check if we can do direct billing to your plan, please complete an authorization form for each plan providing coverage. If you are a parent or caregiver who would like some of the assessment hours to be billed under your name, please also complete the form for yourself.

    If you request for direct billing below, you will automatically be sent the direct billing form upon submission of this form. If you'd like a copy of the form now, it can be found here:

    TELUS Health eClaims Consent Form

    Please email the form to admin@drjuliaryan.ca. When a patient has two insurance plans, the primary coverage is determined by the 'Birthday Rule': the plan belonging to the person whose birthday (month and day) falls earliest in the calendar year holds the primary insurance policy.

    Note that many Equitable and Manulife insurance plans only payout to the client and not the provider. This means that we will collect fees from you by credit card or e-transfer, and can submit insurance claims to Manulife on your behalf. Manulife will then reimburse you.

  • Your direct billing form will be attached to the submission receipt sent to your email address upon completion of this form.

  • Fees & Payment


    Credit Cards


    We require all Clients to have a valid credit card on file.

    We ask all clients to add a valid credit card to their file in case of unpaid or uncovered fees. Your credit card number will be stored securely on file and the payment will be processed through Stripe; we do not have an on-site machine.

    After completing this form, we will reach out to you with next steps for your assessment including instructions for adding a credit card to the file.

  • Acknowledgement of Fees & Payments


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  • End of Section: Fees and Payments

  • Intake Questionnaire


    The next several sections of the form contain questions about the Client's development, family life, social-emotional health, behaviour, learning, and presenting issues that are the focus for assessment. This information informs helps us build an effective, individualized service plan for you, and will be used as part of the assessment itself. Relevant information will be used in our formal assessment report, which also includes our professional findings and recommendations.

    We value your privacy and take active measures to protect the Client's personal health information. Due to these protective measures, your progress is not automatically saved. Your progress will be lost if you exit this webpage before submitting.

    For open-ended questions, please consider being brief. For those that have more to tell us, please consider keeping more detailed notes separately to share with us after the initial file review.

    Contact Us

    If you have any questions about this form, we encourage you to reach out to us.

    You can contact the clinic at 613-699-0825 or admin@drjuliaryan.ca if you have questions about the information in this form while completing it.

    Client Background


  • Intake Questionnaire


    Answer the following questions to the best of your ability.

    Reminder: For open-ended questions, please limit your answer to a few sentences.

  • Presenting Issues


  • Family Information


  • Interests and Strengths


  • Education and/or Occupation


  • Social-Emotional Functioning


  • Medical


  • If applicable, when was the Client's last...

  • Medical


  • Developmental


  • Intake Questionnaire


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  • End of Intake Questionnaire


    You've completed the Assessment Intake Form!

    Submit it whenever you're ready. Remember that your progress is lost if you close this page without submitting the form.

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