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    What If I Still Have Questions?

    This form is for general inquiries only. Please do not include confidential or protected health information.

    This form is not monitored for crisis situations. If you or someone you know is experiencing a mental health crisis, please call or text 988 (Suicide & Crisis Lifeline) or dial 911 for immediate assistance.

    This form is for client inquiries only. Any solicitation will be ignored.

    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.