Appointment Request

Use the form on this page to submit a request for a therapy or counseling appointment with me. I will get back to you as soon as I am able to finalize your session date and time.

  • Date Format: MM slash DD slash YYYY
    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.