Make an Appointment: [email protected] | 845-596-1321

[email protected] | 845-596-1321
  • 845-596-1321
    [email protected]
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    Client Forms

    If you are new, please fill out these forms within 48 hours to confirm the tentative appointment time we discussed.

    Client Intake Form

    Information Sheet

    Limits of Confidentiality

    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
    Brooklyn, NY (Kings County)

    845-596-1321
    [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.