Make an Appointment: [email protected] | (289) 382-9103

[email protected] | (289) 382-9103
Contact
  • (289) 382-9103
    [email protected]

    • Client Forms

    If you are new, please feel free to fill out these intake forms before the first session. These forms can also be filled out during the first session.

    Client Intake Form

    Information Sheet

    Limits of Confidentiality

    Contact Today

    Contact

    Ontario, Canada

    (289) 382-9103
    [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.