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. Name* Email* Phone Preferred Date and Time (I will do my best to accomodate and will call within 24 hours)* Time: How Can I Help? Please leave this field empty. Yes, I want to submit this form 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.