Appointment Request Use the form on this page to send a request for a Counseling or Psychological Testing session with one of our clinicians. We will get back to you shortly to finalize the date and time of your appointment. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Preferred Date and TimeTime:PhoneHow can I help?How Did You Learn Of Our Services?Social MediaFriend/ RelativeGoogle SearchSchoolChurchOtherTerms of Service *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.Submit
