Appointment Request

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Schedule an appointment with our Intake Coordinator

Please complete the form below to schedule an appointment with our Intake Coordinator, Rebecca. This will allow for you to ensure that she is available to talk to you and answer any questions you may have and get you scheduled with a therapist that best fits your needs. 

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.

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