Make an Appointment: [email protected] | (424) 431-4544

Email Me | (424) 431-4544
banner image

Client Forms

If you are new, please fill out these intake forms before our first session.

If you feel that you would like me to collaborate with another provider in order to get a full picture of what is going on, please fill out the following form.

Contact

(424) 431-4544
[email protected]

By submitting this form via this web portal, you acknowledge and accept that risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.