Forms

For individual sessions:

Click here for the intake form and please submit it before our first session.
Click here to view the informed consent form – we’ll complete this together in our first session.

If you'd like me to collaborate with another provider or if we agree to bring in someone else as a resource, simply fill out this form:

Authorization for Release of Information

Contact

Name *

Email *

Phone

Comment or Message

Check the box to be added to e-list and receive monthly newsletter and be notified of public events.

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By submitting this form via this web portal, you acknowledge and accept the 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.

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