Inquiry about Psychological Services

Emergency Assistance

Please note that my services are not intended for emergencies.

Canadian crisis line: Call or text 988 any time if somebody is in emotional crisis.
911: Call 911 or go to your nearest hospital's emergency room if somebody is going to hurt themselves or others.

Your privacy is important to me. This secure form protects your personal and health information in accordance with privacy laws in British Columbia, Canada.

Psychological Service Information

Which psychological service are you interested in?

Individual psychotherapy

Evidence-based, holistic, and compassionate therapy for youth and adults in BC

Professional consultation

For health professionals or organizations seeking support with enhancing their practices

Supervision

For graduate students and pre-licensed professionals

My Information

I am a parent or guardian seeking therapy for my youth (Please enter your youth's information here. You can enter your own information in the next section that appears).

First name

Last name

Pronouns

Date of birth

Email address

Are you OK with Kristen emailing the address above with information about your inquiry and the requested psychological services?

Yes

Parent(s) or Guardian(s) Information

First name

Last name

Relationship to the youth

Pronouns

Email address

Would you like Kristen to email the address above with information about your inquiry and the requested psychological services?

Yes

First name

Last name

Relationship to the youth

Pronouns

Email address

Would you like Kristen to email the address above with information about your inquiry and the requested psychological services?

Yes

My Inquiry

Please briefly describe your reasons for seeking psychological services.

Is there anything else you'd like to share with Kristen?

Do you have any questions for Kristen at this time?

Please note that completing this form does not initiate a psychologist-client relationship together. This type of relationship can be established during our initial therapy session.

Your information will be encrypted.

Inquiry about Psychological Services

Emergency Assistance

Psychological Service Information

My Information

Parent(s) or Guardian(s) Information

My Inquiry

Emergency Assistance

Dr. Kristen Silveira

Registered Psychologist #2832