PMC Appointment Request Form

Complete the appointment request form below ensuring that you complete all required fields to ensure a successful submission. Once your form is submitted, a member of the PMC front desk team will email to schedule an appointment.

If you have questions or have difficulties completing the form, please email pmc@carleton.ca or call 613-520-6608.

Note: This process is for Carleton students accessing PMC services for the first time. If you have previously accessed PMC services and want to schedule a follow-up appointment, please email us at pmc@carleton.ca.

Name

First Last

Carleton enrolment status(Required)

Current undergraduate student

Current graduate student (Master’s or PhD)

Not yet a student/prospective student

I am a….(Required)

…current Carleton student with a disability. I need to register to receive accommodations and services.

…current Carleton student with questions about the PMC

…current Carleton student who may have a disability. I need information about how to get assessed.

…prospective Carleton student with questions about PMC services and documentation requirements.

…prospective Carleton student who has received an offer of admission from Carleton. I have questions about the PMC.

Carleton ID Number(Required)

Cmail Address(Required)

Carleton Email Address(Required)

Secondary Email

Phone Number(Required)

Nature of Disability(Required)

Acquired Brain Injury (e.g. concussion, permanent brain injury)

Autism Spectrum Disorder (ASD)

Attention Deficit Hyperactive Disorder (ADHD)

Chronic Medical Disability (e.g. arthritis, Crohn’s, Lupus, Fibroyalgia, cancer, etc.)

Mobility/Physical Disability (e.g. broken arm/leg, MS, CP, spinal cord injury, etc.)

Blind and/or Partially Sighted

Deaf or Hard of Hearing

Learning Disabilities (LD)

Mental Health (e.g. depression, anxiety, psychosis disorder, etc.)

Other

If you selected "Other" above, please provide details.(Required)

Documentation(Required)

Current psycho-educational/psychological/neuro-psychological assessment completed within the last five (5) years or based on adult-normed testing.

Psycho-educational/psychological/neuro-psychological assessment more than five (5) years old.

I am in the process of being assessed for a disability.

I can have the relevant PMC documentation form(s) completed by a licensed physician.

I have a Disability Verification Form (DVF) completed for financial assistance from my province.

I have an IEP from high school but no other documentation.

I have other documentation.

If you selected "I have other documentation" above, please specify.(Required)

How will you submit your disability documentation?(Required)

Upload to the Ventus Student Portal.

Email to pmc@carleton.ca

Fax to 613-520-3995

Bring to in-person appointment or drop-off in-person prior to appointment.

Preferred Appointment Format(Required)

We will do our best to accommodate your preference, but a virtual appointment may be recommended to avoid scheduling delays.

In-Person at the PMC

Virtual via MS Teams

Phone

When are you available for an appointment?(Required)

Appointments are scheduled during our regular business hours, Monday – Friday, 8:30am-12:00pm and 1:00-4:30pm. Please select all options that typically work with your schedule.

Monday Morning (8:30am-12:00pm)

Monday Afternoon (1:00pm-3:30pm)

Tuesday Morning (8:30am-12:00pm)

Tuesday Afternoon (1:00pm-3:30pm)

Wednesday Morning (8:30am-12:00pm)

Wednesday Afternoon (1:00pm-3:30pm)

Thursday Morning (8:30am-12:00pm)

Thursday Afternoon (1:00pm-3:30pm)

Friday Morning (8:30am-12:00pm)

Friday Afternoon (1:00pm-3:30pm)

Is there any other information you would like us to know related to your appointment request?

What questions and/or information are you hoping to discuss during your appointment?(Required)

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