Client Forms

Client Forms are accessed through my Client Portal. It is common practice for new clients to be invited to the Client Portal after the initial session is scheduled.  

Schedule An Appointment in the Quad Cities

Feel free to complete the form below to request an appointment. If you are unsure whether counseling can be helpful to you, please call and I will be happy to answer any questions you have. I look forward to meeting you! 

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.