Online Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, Click here.

682-292-7720

[email protected]

275 S. Denton Tap Road, Ste. 101
Coppell, TX 75019
108 Russell street Weatherford TX 76086

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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.

Please do not submit any Protected Health Information (PHI).

Coppell Location

Address

275 S. Denton Tap Rd,
Ste. 101,
Coppell, TX 75019

Phone

682-292-7720

Weatherford Location

Address

108 Russell St.,
Weatherford, TX 76086

Phone

682-292-7720

Have some questions first? You can always reach out here,
or email me directly at [email protected]