Appointment Request To schedule an individual therapy or psychological evaluation appointment or to obtain additional information about any of these counseling services, please fill out the form below or give me a call. Request Appointment Please enable JavaScript in your browser to complete this form.Name *E-mail *Phone *Preferred Time and Date *Comment or MessageTerms of Use *Yes, I want to submit this formBy 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.WebsiteSubmit
