If you'd like to request for yourself/ a child/ another person to be placed on our waitlist, please provide the following details regarding the potential client:
* Full name
* Preferred name
* Pronouns (they/ them, she/ her, he/ him etc)
* Date of birth
* Known or suspected neurodivergence, disability(ies), and/ or mental health presentation
* Whether you're seeking psychological therapy and/ or Autism assessment and/ or ADHD assessment
* Brief goals for therapy if requested (to best match you with a psychologist)
* Email (if different)
* Phone (if different or not listed above)
