Contact Information

Welcome to Herald Square Psychology

Thank you for reaching out. Please tell us a little about what you need, and we will get back to you as soon as we can.

1. How can we help you?

What can we do to meet your needs? (select all that apply)

Neuropsychological / Psychological TestingADHDAutismFull batteryMedicalDementiaSchool accommodationsDisabilityPersonal reasons

2. Session format

How would you like to be seen?

In personOnlineHybrid

3. Your details

Full name

Email

Phone

Address

Date of birth

4. Insurance and payment

Do you have insurance?

YesNo

If yes: please upload a clear photo or scan of both sides of your insurance card.

Insurance card - front

Insurance card - back

If no: how would you prefer to pay?

Credit cardCashBank transfer

5. Availability

When are you generally available? (select all that apply)

MorningsEveningsWeekends

6. Report timeline

How soon do you need your report?

1 week (extra fee applies)2 weeksNo deadline

7. Learn more about our services

Have you seen our information and pricing pages?

• General information and prices

• Autism evaluations

• ADHD evaluations

Yes, I haveNot yet

8. How did you hear about us?

(select all that apply)

GoogleOnline searchAI chatWord of mouthAdvertisementLinkedInOur webpageOther webpageOther

If you chose "Other webpage" or "Other", please tell us more (optional)

9. Follow-up

Would you like a follow-up contact to help with recommendations?

Yes, pleaseNo, thank you

Anything else you would like us to know? (optional)