Make an Appointment: [email protected] | (360) 733-4040

[email protected] | (360) 733-4040
Contact
  • (360) 733-4040
    [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. These forms can also be filled out during the first session.

    Client Intake Form – Adult

    Client Intake Form – Youth

    Fees and Payment – Forensic

    Fees and Payment – Non-Forensic

    If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

    Authorization for Release of Information

    Contact
    3112 Main Street

    Vancouver, WA 98663

    (360) 733-4040
    [email protected]

    By 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.