Appointment Request Please feel free to complete the form below to request an appointment. Psychotherapy for Individuals Ready to Feel Alive Again Please enable JavaScript in your browser to complete this form.Name *Email *PhonePreferred Date & TimeComment or MessageBy submitting this form via this web portal, you acknowledge and accept that 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. *Yes, I want to submit this formWebsiteSubmit