Appointment Request

Use the below form to submit an email with your request for a psychotherapy appointment. Please be sure to fill out all fields, so that we may get back in touch with you as soon as possible. We will be in touch shortly to finish scheduling your appointment.

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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.
  • This field is for validation purposes and should be left unchanged.