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Appointment Request

To schedule an individual, children, couples, marriage or family therapy appointment or to obtain additional information about any of our counseling services, please fill out the form below or give us a call. Please identify which provider you are interested in seeing. A listing of our providers can be found on our website; we encourage you to read through information about each therapist to determine who may be the right fit for you.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioners.

“"There is no greater agony than bearing an untold story inside of you." -Maya Angelou“

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.