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Appointment Request

Appointment Request

Please complete the form below to schedule an appointment. I will try my best to accommodate your request and will be in touch ASAP.

~Daytime and evening appointments are available on Tuesdays and Thursdays. Completion of this form does not guarantee an appointment. Your therapist will contact you via email or phone to set up and confirm appointments.~

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.



joannah@therestinitiative.org
770-750-5838