Since August 25th 2021, due to technical issues with this form, I am not receiving any information other than the email address so if you wish to contact me for psychological services, please DO NOT use the form below. Instead, please email me at drnilminidesilva@gmail.com and provide the information requested below in your email.

Please note, I currently have a 2 month waiting list so after November 1st, I will only be able to take new clients in January 2022.

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Name: *

E-mail address: *

Telephone number: *

I would like to start therapy as soon as possible.

I can attend between 10:30am & 6:30pm on a weekday.

An email can be sent to the address provided above.

Voicemail can be left at the number provided above.

Symptoms & diagnoses if any:

Issues or problems to address: *

Desired goals of therapy: *

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The information provided will be sent electronically to Dr. Nilmini De Silva, will be kept completely confidential, and will be used purely for the purposes of prioritizing client requests and for contacting you.

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