Make an Appointment: (239) 275-9665   [email protected]

[email protected] | (239) 275-9665
Contact
  • (239) 275-9665
    [email protected]
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    Client Forms

    If you are new, please feel free to fill out these intake forms before our first session and send them to me via spruce. I will invite you to this platform for this purpose.
    If you feel that you would like to collaborate your session with another provider, simply fill out the following form.
    Contact
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    (239) 275-9665
    [email protected]

    Offering online services in Florida

    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.