Richmond Clinic location:

Intake Form - Richmond Clinic


Please complete the following intake form to initiate a referral and/or to join our wait list. Upon receipt, one of our clinic coordinators will contact you to discuss next steps.

Required by the College of Psychologists of BC, the BC association of Clinical Counsellors, and the BC Speech Language Pathology Association.
If this is a concern, please let us know as soon as possible.
Address line, City, Province, Postal code

* Please note, we cannot guarantee the confidentiality of information transmitted through e-mail including the intake form.  Please be aware of this limitation when contacting us.